Provider Demographics
NPI:1962593327
Name:PARKER, KENNETH BARRETT (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BARRETT
Last Name:PARKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:BARRETT
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:182 INTREPID LN STE B
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2545
Mailing Address - Country:US
Mailing Address - Phone:315-498-6888
Mailing Address - Fax:315-498-6889
Practice Address - Street 1:182 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2545
Practice Address - Country:US
Practice Address - Phone:315-498-6888
Practice Address - Fax:315-498-6889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX-100892OtherNY CHIRO LICENSE #
NYC10892-OBOtherD.C. WORK COMP ID
NYC10892-OBOtherD.C. WORK COMP ID
NYX-100892OtherNY CHIRO LICENSE #