Provider Demographics
NPI:1063424125
Name:BEASLEY, DENNIS ORELL (DC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ORELL
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16771 SW 12TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-6024
Mailing Address - Country:US
Mailing Address - Phone:503-822-5242
Mailing Address - Fax:503-822-5293
Practice Address - Street 1:16771 SW 12TH ST STE E
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6024
Practice Address - Country:US
Practice Address - Phone:503-822-5242
Practice Address - Fax:503-822-5293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28627111N00000X
OR3502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor