Provider Demographics
NPI:1760576102
Name:PARKINSON, ANTHONY VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:PARKINSON
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 1:5903 RIDGEWOOD ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-899-3167
Mailing Address - Fax:601-899-3914
Practice Address - Street 1:5903 RIDGEWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3700
Practice Address - Country:US
Practice Address - Phone:601-899-3167
Practice Address - Fax:601-899-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119654Medicaid
MS00119654Medicaid
MSU61077Medicare UPIN