Provider Demographics
NPI:1447618277
Name:PARKER CHIROPRACTIC
Entity Type:Organization
Organization Name:PARKER CHIROPRACTIC
Other - Org Name:PARKER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDERUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-240-3782
Mailing Address - Street 1:1564 PARKER BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8730
Mailing Address - Country:US
Mailing Address - Phone:207-240-3782
Mailing Address - Fax:
Practice Address - Street 1:1564 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8730
Practice Address - Country:US
Practice Address - Phone:207-240-3782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012440-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center