Healthcare Provider Details

I. General information

NPI: 1235272030
Provider Name (Legal Business Name): ROBERT JOSEPH BECK MADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 GAUSE BLVD E SUITE 302
SLIDELL LA
70461-4235
US

IV. Provider business mailing address

2250 GAUSE BLVD E SUITE 302
SLIDELL LA
70461-4235
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-9332
  • Fax: 985-643-9285
Mailing address:
  • Phone: 985-643-9332
  • Fax: 985-643-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number828
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: