Provider Demographics
NPI:1104026418
Name:PARMENTER, KEITH MICHAEL (DOM)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:PARMENTER
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:160 SW 12TH AVE
Mailing Address - Street 2:102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3119
Mailing Address - Country:US
Mailing Address - Phone:954-574-5277
Mailing Address - Fax:954-574-5228
Practice Address - Street 1:160 SW 12TH AVE
Practice Address - Street 2:102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3119
Practice Address - Country:US
Practice Address - Phone:954-574-5277
Practice Address - Fax:954-574-5228
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP2103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist