Provider Demographics
NPI:1225858202
Name:MEISTER, JACK (ND)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:MEISTER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 E CURRY RD APT 3055
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-0334
Mailing Address - Country:US
Mailing Address - Phone:970-761-0694
Mailing Address - Fax:
Practice Address - Street 1:726 N GREENFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5062
Practice Address - Country:US
Practice Address - Phone:480-508-4226
Practice Address - Fax:480-508-4356
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24-1880175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath