Provider Demographics
NPI:1669582680
Name:PARKER UNIVERSITY
Entity type:Organization
Organization Name:PARKER UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICS
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-438-6932
Mailing Address - Street 1:2540 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5609
Mailing Address - Country:US
Mailing Address - Phone:972-438-6932
Mailing Address - Fax:214-902-3475
Practice Address - Street 1:2600 ELECTRONIC LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1216
Practice Address - Country:US
Practice Address - Phone:972-438-6932
Practice Address - Fax:214-902-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5810OtherBC/BS
TX0A5810OtherBC/BS