MEDICARE: CHARLES REED PARKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	738837662	CA
2	111NI0013X	Independent Medical Examiner Chiropractor	488277388938	CA

General Provider Information

NPI Number	:	1043938442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES REED PARKER MD

Provider Business Mailing Address
First Line	:	6315 SIMPSON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3417
Country	:	US
Telephone Number	:	818-486-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 SIMPSON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3417
Country	:	US
Telephone Number	:	818-486-9692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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