MEDICARE: DEREK AMREIN 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	5002	AZ

General Provider Information

NPI Number	:	1487602678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK AMREIN D.C.

Provider Business Mailing Address
First Line	:	20325 N 51ST AVE
Second Line	:	#108
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5674
Country	:	US
Telephone Number	:	623-561-2511
Fax Number	:	623-581-0845

Provider Business Practice Location Address
First Line	:	20325 N 51ST AVE
Second Line	:	#108
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5674
Country	:	US
Telephone Number	:	623-561-2511
Fax Number	:	623-581-0845

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/18/2007

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