Provider Demographics
NPI:1154416873
Name:PARKER, RICHARD LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:PARKER
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 1:1213 PARIS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-247-8940
Mailing Address - Fax:270-247-8916
Practice Address - Street 1:1213 PARIS ROAD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-247-8940
Practice Address - Fax:270-247-8916
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049331OtherBC/BS
KY61-1170310OtherFEDERAL ID
KY000000049331OtherBC/BS
KY6057001Medicare ID - Type Unspecified