Provider Demographics
NPI:1023177672
Name:PRICE, DEREK PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:PATRICK
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 DESIERTO VERDE
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429-5842
Mailing Address - Country:US
Mailing Address - Phone:928-754-3884
Mailing Address - Fax:
Practice Address - Street 1:1868 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6804
Practice Address - Country:US
Practice Address - Phone:928-763-8313
Practice Address - Fax:928-763-7995
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5736OtherSTATE LICENCE
AZZ103037Medicare PIN
AZ5736OtherSTATE LICENCE