MEDICARE: DEREK PRICE CHIROPRACTIC PLLC

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	5736	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5736	OTHER	AZ	AZ LICENSE
2	U68320	OTHER	AZ	UPIN

General Provider Information

NPI Number	:	1124296165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK PRICE CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	1868 HIWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6804
Country	:	US
Telephone Number	:	928-763-8313
Fax Number	:	928-763-7995

Provider Business Practice Location Address
First Line	:	1868 HIWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6804
Country	:	US
Telephone Number	:	928-763-8313
Fax Number	:	928-763-7995

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DEREK PATRICK PRICE
Credential	:	DC
Telephone Number	:	928-763-8313

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/13/2008

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