Healthcare Provider Details

I. General information

NPI: 1831572619
Provider Name (Legal Business Name): CODY BECKSVOORT D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 803-305-3974
  • Fax: 800-715-1563
Mailing address:
  • Phone: 970-624-5294
  • Fax: 970-267-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0077990
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83783
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: