Provider Demographics
NPI:1710924360
Name:PARKER, DIANN GAIL (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANN
Middle Name:GAIL
Last Name:PARKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1921
Mailing Address - Country:US
Mailing Address - Phone:517-663-7060
Mailing Address - Fax:517-663-7061
Practice Address - Street 1:1322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1921
Practice Address - Country:US
Practice Address - Phone:517-663-7060
Practice Address - Fax:517-663-7061
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B350300OtherBLUE CROSS / BLUE SHIELD
MI1006145OtherMCLAREN HEALTH PLAN
MI1006145OtherMCLAREN HEALTH PLAN
U64879Medicare UPIN