Healthcare Provider Details

I. General information

NPI: 1083849210
Provider Name (Legal Business Name): JACOB JULIUS BECKER FNP-C, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 E BROWN RD UNIT 13
MESA AZ
85213-5412
US

IV. Provider business mailing address

155 N RIP FORD RD UNIT B
SPRING BRANCH TX
78070-2297
US

V. Phone/Fax

Practice location:
  • Phone: 423-432-4148
  • Fax:
Mailing address:
  • Phone: 423-432-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2342
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number317339
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number317339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: