Provider Demographics
NPI:1821402363
Name:MESA CHIROPRACTIC REHAB AND WELLNESS LLC
Entity Type:Organization
Organization Name:MESA CHIROPRACTIC REHAB AND WELLNESS LLC
Other - Org Name:MESA CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-644-1227
Mailing Address - Street 1:613 S MESA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2543
Mailing Address - Country:US
Mailing Address - Phone:480-644-1227
Mailing Address - Fax:480-644-7737
Practice Address - Street 1:613 S MESA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2543
Practice Address - Country:US
Practice Address - Phone:480-644-1227
Practice Address - Fax:480-644-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8395111N00000X
AZ8396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty