Provider Demographics
NPI:1437804580
Name:PARKS, JACOB (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:PARKS
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 1:8711 WINDSOR PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8711 WINDSOR PKWY STE 7
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2296
Practice Address - Country:US
Practice Address - Phone:515-867-2900
Practice Address - Fax:515-867-2902
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor