Healthcare Provider Details

I. General information

NPI: 1154427110
Provider Name (Legal Business Name): BEASLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 WRIGHTSVILLE AVE SUITE 3C
WILMINGTON NC
28403-2575
US

IV. Provider business mailing address

2210 WRIGHTSVILLE AVE SUITE 3C
WILMINGTON NC
28403-2575
US

V. Phone/Fax

Practice location:
  • Phone: 910-392-3100
  • Fax: 910-763-2884
Mailing address:
  • Phone: 910-392-3100
  • Fax: 910-763-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2068
License Number StateNC

VIII. Authorized Official

Name: DR. SEAN A. REESE
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 910-392-3100