Provider Demographics
NPI:1235386962
Name:PARKE, DAVID LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:PARKE
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 1:75 CALLE DE LAS TIENDAS
Mailing Address - Street 2:SUITE #117B
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614
Mailing Address - Country:US
Mailing Address - Phone:520-260-4397
Mailing Address - Fax:
Practice Address - Street 1:75 CALLE DE LAS TIENDAS
Practice Address - Street 2:SUITE #117B
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-260-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor