MEDICARE: MESA CHIROPRACTIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1588733091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	1450 W GUADALUPE RD
Second Line	:	#120
City	:	GILBERT
State	:	AZ
Zip	:	85233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5233 E SOUTHERN AV
Second Line	:	#104
City	:	MESA
State	:	AZ
Zip	:	85206
Country	:	US
Telephone Number	:	480-830-2882
Fax Number	:	480-830-2881

Authorized Official
Title or Position	:	DC PRESIDENT
Name	:	MR. RADMAN RAHIMINEJAD
Credential	:
Telephone Number	:	480-926-7800

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	03/24/2008

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