Provider Demographics
NPI:1356525257
Name:HEALTH SOURCE OF WEST MESA LLC
Entity type:Organization
Organization Name:HEALTH SOURCE OF WEST MESA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-610-2666
Mailing Address - Street 1:1116 S DOBSON RD
Mailing Address - Street 2:STE. 126
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-3918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1116 S DOBSON RD
Practice Address - Street 2:STE. 126
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-3918
Practice Address - Country:US
Practice Address - Phone:480-610-2666
Practice Address - Fax:480-610-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty