MEDICARE: DR. BRUCE EDWARD MOUNSEY D.C.

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	8384	AZ

General Provider Information

NPI Number	:	1386911543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE EDWARD MOUNSEY D.C.

Provider Business Mailing Address
First Line	:	2235 S HWY 89
Second Line	:	STE B7
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-9208
Country	:	US
Telephone Number	:	928-636-6300
Fax Number	:	928-636-1185

Provider Business Practice Location Address
First Line	:	1578 N STATE ROUTE 89
Second Line	:	SUITE 2
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-7624
Country	:	US
Telephone Number	:	928-636-6300
Fax Number	:	928-636-1185

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

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	05/29/2019

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