MEDICARE: DR. BONNIE LEE BECKER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	DC-002773L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0048435000	OTHER	PA	10-DIGIT HMO ID

General Provider Information

NPI Number	:	1285665083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE LEE BECKER D.C.

Provider Business Mailing Address
First Line	:	1995 UPPER ROCKY DALE RD
Second Line	:
City	:	GREEN LANE
State	:	PA
Zip	:	18054-2541
Country	:	US
Telephone Number	:	215-257-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 RIDGE RD
Second Line	:
City	:	TELFORD
State	:	PA
Zip	:	18969-1327
Country	:	US
Telephone Number	:	215-258-5633
Fax Number	:	215-258-5634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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