Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 828 | LA |
NPI | 1235272030 |
---|---|
Provider Name | Dr. Robert Joseph Beck |
First Address | Slidell, LA 70461-4235 |
Second Address | Slidell, LA 70461-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2877-A | BLUE CROSS PROVIDER NO. (01) | LA |
U-13561 | (02) | LA |