Healthcare Provider Details

I. General information

NPI: 1295717403
Provider Name (Legal Business Name): CYNTHIA A. BECKER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 E MAIN ST
MENDOTA IL
61342-1077
US

IV. Provider business mailing address

1403 E MAIN ST
MENDOTA IL
61342-1077
US

V. Phone/Fax

Practice location:
  • Phone: 815-538-2182
  • Fax: 815-539-9163
Mailing address:
  • Phone: 815-538-2182
  • Fax: 815-539-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038006853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: