Healthcare Provider Details

I. General information

NPI: 1821329095
Provider Name (Legal Business Name): JAROD WILLIAM BECKTELL D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 CARLISLE BLVD NE SUITE G
ALBUQUERQUE NM
87110-2867
US

IV. Provider business mailing address

1009 PRINCETON DR NE
ALBUQUERQUE NM
87106-2628
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-7461
  • Fax:
Mailing address:
  • Phone: 505-688-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1018
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: