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General NPI Number Information
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NPI Number | 1568473304
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Entity Type | Organization
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Legal Business Name | BECKER CLINIC LTD
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6206 PETERS CREEK ROAD
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City | ROANOKE
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State | VA
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Zip | 24019
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Country | US
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Telephone | 540-563-0334
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Fax | 540-563-0122
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Provider Business Mailing Address
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Address Line | 6206 PETERS CREEK ROAD
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City | ROANOKE
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State | VA
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Zip | 24019
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Country | US
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Telephone | 540-563-0334
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Fax | 540-563-0122
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MRS. CAROL WADE POWELL
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Credential | RT
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Telephone | 540-563-0334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104000126
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License Number State | VA
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