Provider Demographics
NPI:1447374079
Name:BECK, KENNETH J (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
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 1:5864 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4424
Mailing Address - Country:US
Mailing Address - Phone:716-649-6944
Mailing Address - Fax:716-649-6407
Practice Address - Street 1:5864 CAMP RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4424
Practice Address - Country:US
Practice Address - Phone:716-649-6944
Practice Address - Fax:716-649-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007389-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020332101OtherUNIVERA
NY161452055-01OtherPRISM HEALTH NETWORK
NY668940OtherACN
NY929795OtherMPN
NY002231421OtherBLUE CROSS
NY5802463OtherGHI
NY929795OtherMPN
NY668940OtherACN