Provider Demographics
NPI:1013903582
Name:PARKHURST, BRIAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:PARKHURST
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 1:364 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8656
Mailing Address - Country:US
Mailing Address - Phone:616-392-9500
Mailing Address - Fax:616-392-9662
Practice Address - Street 1:364 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8656
Practice Address - Country:US
Practice Address - Phone:616-392-9500
Practice Address - Fax:616-392-9662
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBP007904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00072955OtherRAILROAD MEDICARE (GA)
MIBP007904OtherBCN
U77941Medicare UPIN
MIM9117001Medicare ID - Type Unspecified