Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038007884 | IL |
N | 225700000X | Massage Therapist | 4864 | OH |
NPI | 1003841701 |
---|---|
Provider Name | Dr. Gary L Becker |
First Address | Bolingbrook, IL 60490-1569 |
Second Address | Woodridge, IL 60517-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 29/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0002207311 | BC/BS (01) | IL |