Provider Demographics
NPI:1861840373
Name:PARKS, KATIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:PARKS
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 1:1221 BOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3732
Mailing Address - Country:US
Mailing Address - Phone:803-708-4258
Mailing Address - Fax:
Practice Address - Street 1:1221 BOWER PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3732
Practice Address - Country:US
Practice Address - Phone:803-708-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor