Provider Demographics
NPI:1982855441
Name:PARKER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PARKER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-929-9976
Mailing Address - Street 1:380 N. MAIN AVE.
Mailing Address - Street 2:PO BOX 88
Mailing Address - City:PARKER
Mailing Address - State:SD
Mailing Address - Zip Code:57053
Mailing Address - Country:US
Mailing Address - Phone:605-297-4481
Mailing Address - Fax:
Practice Address - Street 1:380 N. MAIN AVE.
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:SD
Practice Address - Zip Code:57053
Practice Address - Country:US
Practice Address - Phone:605-297-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S102983Medicare PIN