Provider Demographics
NPI:1831140961
Name:BEASLEY, JEFFREY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
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 1:1335 FLOWERING DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2890
Mailing Address - Country:US
Mailing Address - Phone:731-286-2467
Mailing Address - Fax:731-286-1178
Practice Address - Street 1:1335 FLOWERING DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2890
Practice Address - Country:US
Practice Address - Phone:731-286-2467
Practice Address - Fax:731-286-1178
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0075769OtherBCBS
TN3674340Medicare ID - Type UnspecifiedPROV NUMBER
TNT74666Medicare UPIN