Provider Demographics
NPI:1659503381
Name:ARIZONA CHIROPRACTIC GROUP MIONI DC INC
Entity Type:Organization
Organization Name:ARIZONA CHIROPRACTIC GROUP MIONI DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIONI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-497-9399
Mailing Address - Street 1:2110 E BASELINE RD
Mailing Address - Street 2:SUITE A 5-6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6970
Mailing Address - Country:US
Mailing Address - Phone:480-497-9399
Mailing Address - Fax:
Practice Address - Street 1:2110 E BASELINE RD
Practice Address - Street 2:SUITE A 5-6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6970
Practice Address - Country:US
Practice Address - Phone:480-497-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty