Provider Demographics
NPI:1255629895
Name:ISTOK, MAEGAN RANEA (DC)
Entity type:Individual
Prefix:DR
First Name:MAEGAN
Middle Name:RANEA
Last Name:ISTOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 N GREENFIELD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5044
Mailing Address - Country:US
Mailing Address - Phone:480-219-1042
Mailing Address - Fax:
Practice Address - Street 1:875 N GREENFIELD RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5044
Practice Address - Country:US
Practice Address - Phone:480-219-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor