Healthcare Provider Details

I. General information

NPI: 1891846184
Provider Name (Legal Business Name): DEREK C PRICE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE B105
GILBERT AZ
85297-7318
US

IV. Provider business mailing address

PO BOX 64568
PHOENIX AZ
85082-4568
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-4333
  • Fax: 480-899-7219
Mailing address:
  • Phone: 318-424-4008
  • Fax: 855-230-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7259
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: