Provider Demographics
NPI:1740319706
Name:BEZZIC, ALETA LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:ALETA
Middle Name:LOUISE
Last Name:BEZZIC
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 451234
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-1234
Mailing Address - Country:US
Mailing Address - Phone:918-964-1870
Mailing Address - Fax:
Practice Address - Street 1:60369 E 253 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-0230
Practice Address - Country:US
Practice Address - Phone:918-964-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor