Provider Demographics
NPI:1720007636
Name:PARKS, WILLIAM DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:PARKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3374
Mailing Address - Country:US
Mailing Address - Phone:734-242-6200
Mailing Address - Fax:734-242-3441
Practice Address - Street 1:1331 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3374
Practice Address - Country:US
Practice Address - Phone:734-242-6200
Practice Address - Fax:734-242-3441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1783697Medicaid
MI950E85035OtherBCBS
MI950E85035OtherBCBS
MI0E85035Medicare ID - Type Unspecified