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General NPI Number Information
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NPI Number | 1013339233
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Entity Type | Individual
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Provider Name | DEREK LEGG
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Gender | Male
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 250 W BASELINE RD
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City | TEMPE
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State | AZ
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Zip | 85283-1262
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Country | US
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Telephone | 480-785-1355
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Fax |
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Provider Business Mailing Address
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Address Line | 505 W BASELINE RD 1035
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City | TEMPE
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State | AZ
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Zip | 85283-1169
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Country | US
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Telephone | 217-653-1195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8366
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License Number State | AZ
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