Provider Demographics
NPI:1528712700
Name:MIRY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:MIRY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAYED
Authorized Official - Middle Name:NAWEED
Authorized Official - Last Name:MIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-828-0616
Mailing Address - Street 1:500 BOLLINGER CANYON WAY STE A15
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5297
Mailing Address - Country:US
Mailing Address - Phone:925-828-0616
Mailing Address - Fax:925-475-4335
Practice Address - Street 1:500 BOLLINGER CANYON WAY STE A15
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5297
Practice Address - Country:US
Practice Address - Phone:925-828-0616
Practice Address - Fax:925-475-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty