Provider Demographics
NPI:1750999389
Name:BEESON CHIROPRACTIC LIFE CENTER INC
Entity type:Organization
Organization Name:BEESON CHIROPRACTIC LIFE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-301-9491
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty