Provider Demographics
NPI:1780742189
Name:MIONI, ALEJANDRO A (DC)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:A
Last Name:MIONI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 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:480-497-9229
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:480-497-9229
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6081111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72428Medicare ID - Type Unspecified