Provider Demographics
NPI:1659657302
Name:PARK CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PARK CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER.
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JS
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-226-2666
Mailing Address - Street 1:717 W WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4100
Mailing Address - Country:US
Mailing Address - Phone:906-226-2666
Mailing Address - Fax:906-226-5502
Practice Address - Street 1:717 W WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4100
Practice Address - Country:US
Practice Address - Phone:906-226-2666
Practice Address - Fax:906-226-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty