Provider Demographics
NPI:1164205878
Name:MEINDERTSMA, AUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:MEINDERTSMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E CIVIC CENTER DR APT 2022
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0100
Mailing Address - Country:US
Mailing Address - Phone:512-619-6316
Mailing Address - Fax:
Practice Address - Street 1:1122 S GREENFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2681
Practice Address - Country:US
Practice Address - Phone:480-820-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor