NPIMap

Organization Active NPI

Beckerton Chiropractic PLLC

Doing business as Fernandina Chiropractic Center

  • Chiropractor
  • Yulee, FL
National Provider Identifier
1770018467
Registry record updated Dec 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH11597 Issued in FL
Legal business name
BECKERTON CHIROPRACTIC PLLC
Doing business as
Fernandina Chiropractic Center
Practice address
464073 East State Road 200
Yulee, FL 32034
Phone
(716) 704-9002
NPI assigned
May 1, 2017
Last updated
Dec 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas Patrick Beckerton, D.CNPI 1669856076
Title
Manager/Sole Member
Phone
(716) 704-9002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH11597 FL Primary

Addresses

Primary practice location

464073 East State Road 200
Yulee, FL 32034

Mailing address

463392 East State Road 200
Yulee, FL 32097
Phone (716) 704-9002

Other names 1

  • Fernandina Chiropractic Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170626001662 FL Part B Supplier - Clinic/Group Practice 7810265394 Receives reassigned benefits from 4 practitioners
Practice locations: Yulee, FL

National Provider Directory

National Provider Directory

Locations

463392 State Road 200
Yulee, FL 32097
Phone (904) 491-1345

464073 State Road 200
Yulee, FL 32097
Phone (716) 704-9002

464073 State Road 200
Ste 4
Yulee, FL 32097
Phone (904) 491-1345

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639785600000",
    "number": "1770018467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463392 EAST STATE ROAD 200",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "32097",
            "telephone_number": "716-704-9002",
            "fax_number": "904-513-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464073 EAST STATE ROAD 200",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "32034",
            "telephone_number": "716-704-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BECKERTON CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-01",
        "last_updated": "2021-12-18",
        "certification_date": "2021-12-18",
        "status": "A",
        "authorized_official_last_name": "BECKERTON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "MANAGER/SOLE MEMBER",
        "authorized_official_telephone_number": "716-704-9002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fernandina Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fernandina Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yulee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.