Provider Demographics
NPI:1700880143
Name:BEESON, KATHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:BEESON
Suffix:
Gender:F
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:PO BOX 25191
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-5191
Mailing Address - Country:US
Mailing Address - Phone:928-772-8638
Mailing Address - Fax:928-775-2407
Practice Address - Street 1:8750 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8739
Practice Address - Country:US
Practice Address - Phone:928-772-8638
Practice Address - Fax:928-775-2407
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0942910OtherBLUE CROSS BLUE SHIELD
AZT41387Medicare UPIN