Provider Demographics
NPI:1588307037
Name:MESA FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:MESA FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-203-9649
Mailing Address - Street 1:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-1293
Mailing Address - Country:US
Mailing Address - Phone:480-833-8003
Mailing Address - Fax:480-962-6384
Practice Address - Street 1:1059 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2153
Practice Address - Country:US
Practice Address - Phone:480-833-8003
Practice Address - Fax:480-962-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty