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General NPI Number Information
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NPI Number | 1013126507
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Entity Type | Individual
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Provider Name | KENNETH WAYNE PARKER D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 12453 TIMBERLAND BLVD SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76244-5208
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Country | US
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Telephone | 817-431-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 12628 CLARKSBURG TRL
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City | KELLER
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State | TX
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Zip | 76248-1718
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Country | US
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Telephone | 817-379-6979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10541
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License Number State | TX
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