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General NPI Number Information
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NPI Number | 1083648927
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Entity Type | Individual
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Provider Name | MICHAEL D PRISBREY BS DC PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 6625 S RURAL RD STE 104
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City | TEMPE
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State | AZ
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Zip | 85283-3717
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Country | US
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Telephone | 844-844-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 8307 E PLATA AVE
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City | MESA
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State | AZ
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Zip | 85212-1621
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Country | US
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Telephone | 480-329-5692
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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 | 5970
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10699
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License Number State | AZ
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