Provider Demographics
NPI:1659566818
Name:PARKS DYNAMIC CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PARKS DYNAMIC CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-885-3154
Mailing Address - Street 1:11879 KEMPER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9021
Mailing Address - Country:US
Mailing Address - Phone:530-885-3154
Mailing Address - Fax:530-885-3192
Practice Address - Street 1:11879 KEMPER RD STE 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9021
Practice Address - Country:US
Practice Address - Phone:530-885-3154
Practice Address - Fax:530-885-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659566818OtherNPPES
CABA290AOtherMEDICARE PTAN
CA1659566818OtherNPPES