Provider Demographics
NPI:1124330915
Name:PARRISH, SELENA MARIA (DC)
Entity type:Individual
Prefix:DR
First Name:SELENA
Middle Name:MARIA
Last Name:PARRISH
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 1:80 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935
Mailing Address - Country:US
Mailing Address - Phone:863-675-0421
Mailing Address - Fax:863-342-8149
Practice Address - Street 1:80 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:863-675-0421
Practice Address - Fax:863-342-8149
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2208JOtherBCBS
FLDI388ZMedicare PIN