MEDICARE: MICHELLE DERBY L.AC

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	171100000X	Acupuncturist	547	AZ

General Provider Information

NPI Number	:	1356770028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DERBY L.AC

Provider Business Mailing Address
First Line	:	42101 N 41ST DR STE C-152
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3816
Country	:	US
Telephone Number	:	602-478-4004
Fax Number	:	602-374-3123

Provider Business Practice Location Address
First Line	:	42101 N 41ST DR STE C-152
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3816
Country	:	US
Telephone Number	:	602-478-4004
Fax Number	:	602-483-1662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	07/02/2021

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Directions to “ MICHELLE DERBY L.AC” Practice Location

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