Provider Demographics
NPI:1184648107
Name:PARSONS, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:PARSONS
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 1:1601 S WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMANCHE
Mailing Address - State:IA
Mailing Address - Zip Code:52730-1711
Mailing Address - Country:US
Mailing Address - Phone:563-259-1314
Mailing Address - Fax:
Practice Address - Street 1:1601 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CAMANCHE
Practice Address - State:IA
Practice Address - Zip Code:52730-1711
Practice Address - Country:US
Practice Address - Phone:563-259-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10881201OtherCAQH
IA46554OtherWELLMARK BC/BS
IA624912OtherACN
IA0178228Medicaid
IA0178228Medicaid