MEDICARE: ELENI-JAMES BECTON

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	14867	TX

General Provider Information

NPI Number	:	1861153058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENI-JAMES BECTON

Provider Business Mailing Address
First Line	:	6012 AZURE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2627
Country	:	US
Telephone Number	:	505-933-2584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 BEACH ST STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2309
Country	:	US
Telephone Number	:	817-531-7246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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