Provider Demographics
NPI:1588870372
Name:BECK, CHARLES ALLEN JR (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLEN
Last Name:BECK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-3109
Mailing Address - Country:US
Mailing Address - Phone:502-608-0261
Mailing Address - Fax:
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:SUITE 235
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-228-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012192A204D00000X
IN02003209A204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201088610Medicaid
IN201088610Medicaid