Provider Demographics
NPI:1568652766
Name:GREGORY V PARSONS PA
Entity Type:Organization
Organization Name:GREGORY V PARSONS PA
Other - Org Name:ADVANCED CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-765-6804
Mailing Address - Street 1:1122 S PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-8537
Mailing Address - Country:US
Mailing Address - Phone:208-765-6804
Mailing Address - Fax:888-338-4609
Practice Address - Street 1:1122 S PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-8537
Practice Address - Country:US
Practice Address - Phone:208-765-6804
Practice Address - Fax:888-338-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50389OtherWASHINGTON LABOR AND INDU
350042012OtherMEDICARE RAILROAD
1374336OtherMEDICARE GROUP ID
C1476OtherBLUE CROSS
000010006910OtherBLUE SHIELD