Provider Demographics
NPI:1588733091
Name:MESA CHIROPRACTIC CORP
Entity type:Organization
Organization Name:MESA CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DC PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RADMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-7800
Mailing Address - Street 1:1450 W GUADALUPE RD
Mailing Address - Street 2:#120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5233 E SOUTHERN AV
Practice Address - Street 2:#104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-830-2882
Practice Address - Fax:480-830-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106364Medicare PIN