MEDICARE: MS. DENISE JENDERZAK DACM, 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	0713	AZ

General Provider Information

NPI Number	:	1598987869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE JENDERZAK DACM, L.AC.

Provider Business Mailing Address
First Line	:	4435 E BROADWAY RD STE 4
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-2012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4435 E BROADWAY RD STE 4
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-2012
Country	:	US
Telephone Number	:	480-832-0966
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/26/2018

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