Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3121 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 3121 | AZ |
NPI | 1205830650 |
---|---|
Provider Name | Dr. Alan L Beeson |
First Address | Prescott Valley, AZ 86312-5191 |
Second Address | Prescott Valley, AZ 86314-8739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 18/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0942900 | BLUE CROSS BLUE SHIELD (01) | AZ |
T41386 | (02) | AZ |