Provider Demographics
NPI:1083648927
Name:PRISBREY, MICHAEL D (BS DC PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:PRISBREY
Suffix:
Gender:M
Credentials:BS DC PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:480-329-5692
Mailing Address - Fax:
Practice Address - Street 1:6625 S RURAL RD STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:844-844-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5970111N00000X
AZ10699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor