Provider Demographics
NPI:1790804441
Name:MEGUIN CHIROPRACTIC CLINIC,LLC
Entity Type:Organization
Organization Name:MEGUIN CHIROPRACTIC CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MEGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-334-5010
Mailing Address - Street 1:15182 N 75TH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4722
Mailing Address - Country:US
Mailing Address - Phone:623-334-5010
Mailing Address - Fax:623-334-0742
Practice Address - Street 1:15182 N 75TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4722
Practice Address - Country:US
Practice Address - Phone:623-334-5010
Practice Address - Fax:623-334-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0243960OtherBCBS
AZT41943Medicare UPIN