Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2301008073 | MI |
NPI | 1023070943 |
---|---|
Provider Name | Dr. Kevin T Parker |
First Address | Okemos, MI 48864-1803 |
Second Address | Okemos, MI 48864-1803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0C35089 | BCBSM PROVIDER NUMBER (01) | MI |
1004890 | MCLAREN HEALTH PLAN (01) | MI |
200000002510 | PHYSICANS HEALTH PLAN (01) | MI |