MEDICARE: BECK WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2006021591	MO

General Provider Information

NPI Number	:	1194928119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECK WELLNESS CENTER

Provider Business Mailing Address
First Line	:	5422 SOUTHFIELD CTR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5907
Country	:	US
Telephone Number	:	314-843-2325
Fax Number	:	314-843-2329

Provider Business Practice Location Address
First Line	:	5422 SOUTHFIELD CTR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5907
Country	:	US
Telephone Number	:	314-843-2325
Fax Number	:	314-843-2329

Authorized Official
Title or Position	:	OWNER
Name	:	MARK A BECK
Credential	:	DC
Telephone Number	:	314-843-2325

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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