Provider Demographics
NPI:1609131432
Name:ARDMORE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:ARDMORE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BESHERSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-423-2445
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty