Healthcare Provider Details

I. General information

NPI: 1245163609
Provider Name (Legal Business Name): GEMMA MAE BECK DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

400 SELBY AVE STE G2
SAINT PAUL MN
55102-4520
US

IV. Provider business mailing address

7695 ADDISEN CT
INVER GROVE MN
55077-4550
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-6678
  • Fax:
Mailing address:
  • Phone: 651-757-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2143
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: