Provider Demographics
NPI:1245539279
Name:PARKER, MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:PARKER
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:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0619
Mailing Address - Country:US
Mailing Address - Phone:682-214-0408
Mailing Address - Fax:
Practice Address - Street 1:213 OLD ANNETTA RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4455
Practice Address - Country:US
Practice Address - Phone:682-214-0408
Practice Address - Fax:817-441-2811
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU53866Medicare PIN