Provider Demographics
NPI:1386980951
Name:PARKER, KAITLIN BETH (DC)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:BETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:B
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1121 S. BOWMAN
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-712-1022
Mailing Address - Fax:
Practice Address - Street 1:1121 S. BOWMAN
Practice Address - Street 2:SUITE C-3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-712-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor