Provider Demographics
NPI:1437383767
Name:PARKER, BRUCE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
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 1:22917 PACIFIC COAST HWY
Mailing Address - Street 2:STE 220
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-6407
Mailing Address - Country:US
Mailing Address - Phone:310-456-7721
Mailing Address - Fax:
Practice Address - Street 1:22917 PACIFIC COAST HWY
Practice Address - Street 2:STE 220
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-6407
Practice Address - Country:US
Practice Address - Phone:310-456-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor