Provider Demographics
NPI:1407184799
Name:PARKES, DEREK JASON MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JASON MATTHEW
Last Name:PARKES
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 1:7084 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3968
Mailing Address - Country:US
Mailing Address - Phone:816-289-7030
Mailing Address - Fax:
Practice Address - Street 1:205 6TH AVE
Practice Address - Street 2:#3
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2569
Practice Address - Country:US
Practice Address - Phone:816-289-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7499532-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor