Healthcare Provider Details

I. General information

NPI: 1336220078
Provider Name (Legal Business Name): TIMOTHY C BECKERING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 EAST MAIN ST.
CORFU NY
14036
US

IV. Provider business mailing address

PO BOX 8541
ENDWELL NY
13762-8541
US

V. Phone/Fax

Practice location:
  • Phone: 607-221-7840
  • Fax:
Mailing address:
  • Phone: 607-221-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: