Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | IL |
NPI | 1003980244 |
---|---|
Provider Name | David Brent Parish |
First Address | Flossmoor, IL 60422-0447 |
Second Address | Flossmoor, IL 60422-1546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |