Provider Demographics
NPI:1780719690
Name:PARKS, ERICH ROSS (DC)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:ROSS
Last Name:PARKS
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 1:11879 KEMPER RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9021
Mailing Address - Country:US
Mailing Address - Phone:530-885-3154
Mailing Address - Fax:
Practice Address - Street 1:11879 KEMPER RD
Practice Address - Street 2:SUITE #3
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9021
Practice Address - Country:US
Practice Address - Phone:530-885-3154
Practice Address - Fax:530-885-3192
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0147160111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0147160Medicare ID - Type Unspecified