Provider Demographics
NPI:1104855006
Name:PARKHURST CHIROPRACTIC LIFE CENTER PLC
Entity Type:Organization
Organization Name:PARKHURST CHIROPRACTIC LIFE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-392-9500
Mailing Address - Street 1:364 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8656
Mailing Address - Country:US
Mailing Address - Phone:616-392-9500
Mailing Address - Fax:616-392-9662
Practice Address - Street 1:364 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8656
Practice Address - Country:US
Practice Address - Phone:616-392-9500
Practice Address - Fax:616-392-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G010320OtherBLUE CROSS BLUE SHIELD
MIDA8102OtherRAILROAD MEDICARE
MI950G010320OtherBLUE CROSS BLUE SHIELD