Provider Demographics
NPI:1104989227
Name:PARKS, PERRY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:ALAN
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 1:113 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELMOND
Mailing Address - State:IA
Mailing Address - Zip Code:50421-1023
Mailing Address - Country:US
Mailing Address - Phone:641-444-3901
Mailing Address - Fax:641-444-7429
Practice Address - Street 1:113 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:BELMOND
Practice Address - State:IA
Practice Address - Zip Code:50421-1023
Practice Address - Country:US
Practice Address - Phone:641-444-3901
Practice Address - Fax:641-444-7429
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282251Medicaid
IA28225Medicare ID - Type Unspecified
IA0282251Medicaid