Provider Demographics
NPI:1710166582
Name:PRISBREY PC
Entity Type:Organization
Organization Name:PRISBREY PC
Other - Org Name:PRISBREY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRISBREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-329-5692
Mailing Address - Street 1:8307 E PLATA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1621
Mailing Address - Country:US
Mailing Address - Phone:480-357-5856
Mailing Address - Fax:
Practice Address - Street 1:5440 E SOUTHERN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2779
Practice Address - Country:US
Practice Address - Phone:480-218-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71281Medicare PIN
AZU75054Medicare UPIN