Provider Demographics
NPI:1154454197
Name:BESHERSE, JEFFREY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAY
Last Name:BESHERSE
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 1:29825 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:AL
Mailing Address - Zip Code:35739
Mailing Address - Country:US
Mailing Address - Phone:256-423-2445
Mailing Address - Fax:256-423-6017
Practice Address - Street 1:29825 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:AL
Practice Address - Zip Code:35739
Practice Address - Country:US
Practice Address - Phone:256-423-2445
Practice Address - Fax:256-423-6017
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51001101OtherBCBS