Provider Demographics
NPI:1366516171
Name:MESHBESHER CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:MESHBESHER CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESHBESHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-823-5456
Mailing Address - Street 1:2917 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2155
Mailing Address - Country:US
Mailing Address - Phone:612-823-5456
Mailing Address - Fax:
Practice Address - Street 1:2917 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2155
Practice Address - Country:US
Practice Address - Phone:612-823-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty