Provider Demographics
NPI:1891914172
Name:BEASON, JOHN DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BEASON
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 1:39899 BALENTINE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5355
Mailing Address - Country:US
Mailing Address - Phone:510-252-1707
Mailing Address - Fax:
Practice Address - Street 1:39899 BALENTINE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5355
Practice Address - Country:US
Practice Address - Phone:510-252-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor