Healthcare Provider Details

I. General information

NPI: 1700880143
Provider Name (Legal Business Name): KATHY J BEESON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 E VALLEY RD
PRESCOTT VALLEY AZ
86314-8739
US

IV. Provider business mailing address

PO BOX 25191
PRESCOTT VALLEY AZ
86312-5191
US

V. Phone/Fax

Practice location:
  • Phone: 928-772-8638
  • Fax: 928-775-2407
Mailing address:
  • Phone: 928-772-8638
  • Fax: 928-775-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3004
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: