Provider Demographics
NPI:1962587907
Name:PAROLISE, ANTHONY MARTIN (DC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MARTIN
Last Name:PAROLISE
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 1:900 I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4313
Mailing Address - Country:US
Mailing Address - Phone:209-826-9484
Mailing Address - Fax:209-826-6412
Practice Address - Street 1:900 I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4313
Practice Address - Country:US
Practice Address - Phone:209-826-9484
Practice Address - Fax:209-826-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0207370Medicare ID - Type Unspecified