Provider Demographics
NPI:1043208564
Name:PARKER, KENNETH ELDON (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ELDON
Last Name:PARKER
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 1:127 AVENUE C
Mailing Address - Street 2:STE A
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2768
Mailing Address - Country:US
Mailing Address - Phone:360-568-4185
Mailing Address - Fax:360-568-2377
Practice Address - Street 1:127 AVENUE C
Practice Address - Street 2:STE A
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2768
Practice Address - Country:US
Practice Address - Phone:360-568-4185
Practice Address - Fax:360-568-2377
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89128Medicare UPIN
WAAB27288Medicare ID - Type Unspecified