Provider Demographics
NPI:1871553172
Name:BECCUE, ROBERT WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BECCUE
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 1:139 BANNER WAY
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1813
Mailing Address - Country:US
Mailing Address - Phone:814-404-0224
Mailing Address - Fax:
Practice Address - Street 1:341 SCIENCE PARK RD
Practice Address - Street 2:SUITE203
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2287
Practice Address - Country:US
Practice Address - Phone:814-272-3555
Practice Address - Fax:814-272-3556
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019530350001Medicaid
PA0019530350001Medicaid