Provider Demographics
NPI:1457471203
Name:PARKER, DAVID S (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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 1:904 DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1340
Mailing Address - Country:US
Mailing Address - Phone:717-738-2555
Mailing Address - Fax:717-738-2557
Practice Address - Street 1:904 DAWN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1340
Practice Address - Country:US
Practice Address - Phone:717-738-2555
Practice Address - Fax:717-738-5199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC -003403-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232463005OtherFEDERAL TAX ID
PA127892Medicare ID - Type Unspecified