Organization Active NPI

Mesa Chiropractic Rehab and Wellness LLC

  • Chiropractor
  • Mesa, AZ
National Provider Identifier
1821402363
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
8395 Issued in AZ
Legal business name
MESA CHIROPRACTIC REHAB AND WELLNESS LLC
Practice address
613 S Mesa Dr
Mesa, AZ 85210-2543
Phone
(480) 644-1227
Fax
(480) 644-7737
NPI assigned
Jun 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eric Liebl, DC
Title
Chiropractor/Owner
Phone
(480) 644-1227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 8395 AZ Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 8396 AZ

Addresses

Primary practice location

613 S Mesa Dr
Mesa, AZ 85210-2543

Mailing address

613 S Mesa Dr
Mesa, AZ 85210-2543
Phone (480) 644-1227

Other names 2

  • Mesa Chiropractic and Rehab Doing business as
  • Mesa Chiropractic and Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140818002542 AZ Part B Supplier - Clinic/Group Practice 1052538873 Receives reassigned benefits from 1 practitioner
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Locations

613 S Mesa Dr
Mesa, AZ 85210
Phone (480) 644-1227

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1821402363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 S MESA DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852102543",
            "telephone_number": "480-644-1227",
            "fax_number": "480-644-7737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 S MESA DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852102543",
            "telephone_number": "480-644-1227",
            "fax_number": "480-644-7737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA CHIROPRACTIC REHAB AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "LIEBL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "480-644-1227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8395",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Chiropractic and Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mesa Chiropractic and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.