Provider Demographics
NPI:1891997714
Name:PARKS, CALVIN H
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:H
Last Name:PARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CALVIN
Other - Middle Name:H
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1321 HUNTSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3603
Mailing Address - Country:US
Mailing Address - Phone:931-433-4478
Mailing Address - Fax:931-433-4478
Practice Address - Street 1:1321 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-433-4478
Practice Address - Fax:931-433-4478
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3671360Medicare ID - Type Unspecified