Healthcare Provider Details

I. General information

NPI: 1083648927
Provider Name (Legal Business Name): MICHAEL D PRISBREY BS DC PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 S RURAL RD STE 104
TEMPE AZ
85283-3717
US

IV. Provider business mailing address

8307 E PLATA AVE
MESA AZ
85212-1621
US

V. Phone/Fax

Practice location:
  • Phone: 844-844-4755
  • Fax:
Mailing address:
  • Phone: 480-329-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10699
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5970
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: