Provider Demographics
NPI:1861528481
Name:BEASLEY, BRECK MARKHAM (DC)
Entity type:Individual
Prefix:DR
First Name:BRECK
Middle Name:MARKHAM
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 1:210 W PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2538
Mailing Address - Country:US
Mailing Address - Phone:901-475-1100
Mailing Address - Fax:901-475-1105
Practice Address - Street 1:210 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2538
Practice Address - Country:US
Practice Address - Phone:901-475-1100
Practice Address - Fax:901-475-1105
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3678363Medicare ID - Type Unspecified
TNU61428Medicare UPIN