Provider Demographics
NPI:1093773749
Name:DEESE, JOHN ASHLEY (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ASHLEY
Last Name:DEESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2219
Mailing Address - Country:US
Mailing Address - Phone:910-521-3093
Mailing Address - Fax:910-521-3095
Practice Address - Street 1:812 CANDY PARK RD
Practice Address - Street 2:SUITE 6103
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9129
Practice Address - Country:US
Practice Address - Phone:910-521-3093
Practice Address - Fax:910-521-3095
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC350054681OtherRAILROAD MEDICARE
NC08498OtherBLUE CROSS BLUS SHIELD #
NC8908498Medicaid
NC8908498Medicaid
NC8908498Medicaid