Provider Demographics
NPI:1962567594
Name:BECK, FRED (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:BECK
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 1:1391 S OCEAN BLVD
Mailing Address - Street 2:#207
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7112
Mailing Address - Country:US
Mailing Address - Phone:954-292-8279
Mailing Address - Fax:954-782-1965
Practice Address - Street 1:1876 N UNIVERSITY DR
Practice Address - Street 2:308 E
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4130
Practice Address - Country:US
Practice Address - Phone:954-323-6688
Practice Address - Fax:958-782-1965
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO3132111N00000X
NYX002238-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0003132OtherFLORIDA LICENSE NUMBER
NYX002238--1OtherNEW YORK LICENSE
FLU69388Medicare UPIN
FLCH0003132OtherFLORIDA LICENSE NUMBER