MEDICARE: DERRICK MCBRIDE

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	0002069	CO

General Provider Information

NPI Number	:	1992190300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK MCBRIDE

Provider Business Mailing Address
First Line	:	2685 S DAYTON WAY APT 252
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-3955
Country	:	US
Telephone Number	:	805-252-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3431
Country	:	US
Telephone Number	:	805-252-6252
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	04/02/2015

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Directions to “ DERRICK MCBRIDE ” Practice Location

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