Healthcare Provider Details

I. General information

NPI: 1063424125
Provider Name (Legal Business Name): DENNIS ORELL BEASLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16771 SW 12TH ST STE E
SHERWOOD OR
97140-6024
US

IV. Provider business mailing address

16771 SW 12TH ST STE E
SHERWOOD OR
97140-6024
US

V. Phone/Fax

Practice location:
  • Phone: 503-822-5242
  • Fax: 503-822-5293
Mailing address:
  • Phone: 503-822-5242
  • Fax: 503-822-5293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3502
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: