Provider Demographics
NPI:1033480751
Name:KIMBERLY A. BESUDEN D.C., P.A.
Entity Type:Organization
Organization Name:KIMBERLY A. BESUDEN D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-839-3006
Mailing Address - Street 1:267 W COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4269
Mailing Address - Country:US
Mailing Address - Phone:407-647-3244
Mailing Address - Fax:407-647-4790
Practice Address - Street 1:267 W COMSTOCK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4269
Practice Address - Country:US
Practice Address - Phone:407-647-3244
Practice Address - Fax:407-647-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55260Medicare PIN