Provider Demographics
NPI:1427264621
Name:BECKER, ELLIOT DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DOUGLAS
Last Name:BECKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4071
Mailing Address - Country:US
Mailing Address - Phone:770-932-7800
Mailing Address - Fax:770-932-7832
Practice Address - Street 1:525 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4071
Practice Address - Country:US
Practice Address - Phone:770-932-7800
Practice Address - Fax:770-932-7832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor