Provider Demographics
NPI:1124627286
Name:PARKER, KIRSTEN RENE
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:RENE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N PENELOPE ST STE C
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3127
Mailing Address - Country:US
Mailing Address - Phone:512-556-0211
Mailing Address - Fax:512-556-0211
Practice Address - Street 1:750 COUNTY ROAD 234 BLDG 1
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4426
Practice Address - Country:US
Practice Address - Phone:512-556-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor