Provider Demographics
NPI:1700821055
Name:BEASLEY, SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:BEASLEY
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 1:4102 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1512
Mailing Address - Country:US
Mailing Address - Phone:870-779-9924
Mailing Address - Fax:870-779-9329
Practice Address - Street 1:4102 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1512
Practice Address - Country:US
Practice Address - Phone:870-779-9924
Practice Address - Fax:870-779-9329
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X510Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER