Provider Demographics
NPI:1316252372
Name:ROBERT J. PARKS, D.C. P.A.
Entity type:Organization
Organization Name:ROBERT J. PARKS, D.C. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DCPA
Authorized Official - Phone:727-345-7113
Mailing Address - Street 1:6415 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1301
Mailing Address - Country:US
Mailing Address - Phone:727-345-7113
Mailing Address - Fax:727-343-9407
Practice Address - Street 1:6415 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1301
Practice Address - Country:US
Practice Address - Phone:727-345-7113
Practice Address - Fax:727-343-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88048Medicare PIN
FLU50629Medicare UPIN