Provider Demographics
NPI:1477553949
Name:PARENT, DORIAN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:
Last Name:PARENT
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 S GRANTS LNDG
Mailing Address - Street 2:
Mailing Address - City:LAKE LEELANAU
Mailing Address - State:MI
Mailing Address - Zip Code:49653-9694
Mailing Address - Country:US
Mailing Address - Phone:231-256-2725
Mailing Address - Fax:231-256-2725
Practice Address - Street 1:6769 COURTLAND DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9606
Practice Address - Country:US
Practice Address - Phone:616-863-9482
Practice Address - Fax:616-863-9486
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU96451Medicare UPIN
MI0N73410Medicare ID - Type UnspecifiedMEDICARE ID