MEDICARE: DEREK C PRICE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7259	AZ

General Provider Information

NPI Number	:	1891846184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK C PRICE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	318-424-4008
Fax Number	:	855-230-1466

Provider Business Practice Location Address
First Line	:	3530 S VAL VISTA DR STE B105
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7318
Country	:	US
Telephone Number	:	480-899-4333
Fax Number	:	480-899-7219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	04/29/2019

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