Provider Demographics
NPI:1871682377
Name:PARKS, GERALD WILLIAM (DC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WILLIAM
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 1:10420 N LA CANADA DRIVE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7025
Mailing Address - Country:US
Mailing Address - Phone:520-544-2445
Mailing Address - Fax:520-544-0452
Practice Address - Street 1:10420 N LA CANADA DR
Practice Address - Street 2:SUITE #120
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9602
Practice Address - Country:US
Practice Address - Phone:520-544-2445
Practice Address - Fax:520-544-0452
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3995/2165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3995/2165OtherDC/PT STATE LICENSE
AZAZ0230070OtherBCBS IDENTIFICATION
AZT42016Medicare UPIN