Healthcare Provider Details

I. General information

NPI: 1386671626
Provider Name (Legal Business Name): BONNIE L BECKER DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIDGE RD
TELFORD PA
18969-1327
US

IV. Provider business mailing address

3 RIDGE RD
TELFORD PA
18969-1327
US

V. Phone/Fax

Practice location:
  • Phone: 215-258-5633
  • Fax: 215-258-5634
Mailing address:
  • Phone: 215-258-5633
  • Fax: 215-258-5634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-002773L
License Number StatePA

VIII. Authorized Official

Name: DR. BONNIE LEE BECKER
Title or Position: OWNER
Credential: DC
Phone: 215-258-5633