Provider Demographics
NPI:1548475536
Name:BECK, JONATHAN E (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:BECK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 HARBOR LN N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5109
Mailing Address - Country:US
Mailing Address - Phone:763-383-1111
Mailing Address - Fax:
Practice Address - Street 1:3021 HARBOR LN N
Practice Address - Street 2:SUITE 109
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5109
Practice Address - Country:US
Practice Address - Phone:763-383-1111
Practice Address - Fax:763-383-1112
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor