DESERT RIDGE SPINE, INC (NPI# 1912035965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912035965 |
| Entity Type | Organization |
| Organization Name | DESERT RIDGE SPINE, INC |
| Practice Address |
3035 S Ellsworth Rd Suite 109 Mesa AZ 85212-2160 |
| Practice Telephone | 4808323318 |
| Practice Fax Number | 4806217208 |
| Mailing Telephone | 4808323318 |
| Mailing Fax Number | 4806217208 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-10-09 |
| Authorized Official Name | DR. TOM OHARA (PRESIDENT) |
| Authorized Official Telephone | 4808323318 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | DC4914 | AZ | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | BLUE CROSS | AZ0236730 | 01 |
| Street Address |
3035 S ELLSWORTH RD SUITE 109 |
| City | MESA |
| State | AZ |
| Zip Code | 85212-2160 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245222074 | Karen Marie Acevedo-mogharbel | Family Medicine | 3035 S Ellsworth Rd, Suite 103, Mesa, AZ 85212 | 2005-08-18 |
| 1194173666 | Kirsten Fogarty | Physical Therapist | 3035 S Ellsworth Rd, Bldg 4 Ste 128, Mesa, AZ 85212-2160 | 2016-05-25 |
| 1750762142 | Amelia Mae Campbell | Nurse Practitioner | 3035 S Ellsworth Rd, Suite 135, Mesa, AZ 85212-2160 | 2015-06-11 |
| 1780090373 | Timothy Hinton | Physical Therapist | 3035 S Ellsworth Rd, Bdlg 164 Suite 128, Mesa, AZ 85212-2160 | 2014-07-03 |
| 1730480666 | Eric James Bloom | Physical Therapist | 3035 S Ellsworth Rd, Building 4, Suite 128, Mesa, AZ 85212-2160 | 2010-11-09 |
| 1003145715 | Joshua N Lacanlale | Physical Therapist | 3035 S Ellsworth Rd, Bldg 4, #128, Mesa, AZ 85212-2160 | 2009-12-09 |
| 1760404495 | Eric Reid Nielson | Dentist | 3035 S Ellsworth Rd, 138, Mesa, AZ 85212-2160 | 2006-07-24 |
| 1811938962 | Stacia B Kagie | Family Medicine | 3035 S Ellsworth Rd, Suite 103, Mesa, AZ 85212-2136 | 2006-06-09 |
| 1144275025 | Surgicare Sheridan Surgical Services | Preferred Provider Organization | 3035 S Ellsworth Rd, Suite 104, Mesa, AZ 85212-2160 | 2006-05-22 |
| 1811941321 | Arizona Preferred Primary Care,plc | Family Medicine | 3035 S Ellsworth Rd, Suite 103, Mesa, AZ 85212 | 2006-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922610302 | West Point Optical Group | Optometrist | 10706 E Point Twenty-two Blvd, #107, Mesa, AZ 85212 | 2020-08-18 |
| 1215553565 | Andrew Eugene Pak | Dentist | 10664 East Point Twenty-two Blvd, Mesa, AZ 85212 | 2020-06-23 |
| 1588200265 | Signal Butte Kids Dentistry and Orthodontics, LLP | Dentist | 10664 E. Point Twenty Two Blvd, Mesa, AZ 85212 | 2019-11-18 |
| 1194371526 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 4316 S Signal Butte Rd, Mesa, AZ 85212 | 2019-08-12 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1033623541 | Latanya Olivia Edenburgs | Case Manager/Care Coordinator | 10436 E Radiant Ave., Mesa, AZ 85212 | 2017-11-20 |
| 1205355880 | Linda Okafor | Nurse Practitioner | 4719 S Calderon Circle, Mesa, AZ 85212 | 2017-09-14 |
| 1689121188 | Agh Mesa LLC | General Acute Care Hospital | 9130 East Elliot Road, Mesa, AZ 85212 | 2016-09-01 |
| 1861841918 | Ryan Blake | Dentist | 4425 S. Mountain Road, Ste 109, Mesa, AZ 85212 | 2016-06-09 |
| 1083089460 | White Glove Health | Nurse Practitioner | 2906 S Lynch Cr, Mesa, AZ 85212 | 2015-12-10 |
| Find all providers in zip 85212 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396359626 | Adapt Chiropractic Pllc | Chiropractor | 1728 S Greenfield Rd Ste 109, Mesa, AZ 85206-3484 | 2020-09-03 |
| 1699391052 | Emily Weber | Chiropractor | 3426 E Baseline Rd, Mesa, AZ 85204-7291 | 2020-06-22 |
| 1285280099 | Mesa Chiropractic Pllc | Chiropractor | 6731 E Brown Rd Ste 101, Mesa, AZ 85205-4964 | 2019-08-16 |
| 1801352406 | Kwd Enterprises, LLC | Chiropractor | 1107 S Gilbert Rd Ste 111, Mesa, AZ 85204-5233 | 2019-02-19 |
| 1124524111 | Bryce Garst | Chiropractor | 6836 E Brown Rd Ste 102, Mesa, AZ 85207-3756 | 2018-03-30 |
| 1508369174 | Colby Ivan Davis | Chiropractor | 4904 S Power Rd Ste 105, Mesa, AZ 85212-3610 | 2018-03-09 |
| 1366953200 | Yunjae Park | Chiropractor | 1116 S Dobson Rd Ste 126, Mesa, AZ 85202-3920 | 2017-10-18 |
| 1841714631 | J. Susanne Davis | Chiropractor | 62 N. Stapley Drive, Mesa, AZ 85203 | 2017-08-02 |
| 1285179457 | Tecla Fuller | Chiropractor | 1728 S Greenfield Rd, Suite 109, Mesa, AZ 85206-3485 | 2016-12-27 |
| 1548716780 | Pain Stop Accident Injury LLC | Chiropractor | 425 E 11th Ave, Mesa, AZ 85204 | 2016-08-28 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.