Healthcare Provider Details

I. General information

NPI: 1285665083
Provider Name (Legal Business Name): BONNIE LEE BECKER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIDGE RD
TELFORD PA
18969-1327
US

IV. Provider business mailing address

1995 UPPER ROCKY DALE RD
GREEN LANE PA
18054-2541
US

V. Phone/Fax

Practice location:
  • Phone: 215-258-5633
  • Fax: 215-258-5634
Mailing address:
  • Phone: 215-257-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC-002773L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: