MEDICARE: DR. JAMES T. PARK APRN,FNP-C,DC

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	111N00000X	Chiropractor	6892	TX
2	363LF0000X	Family Nurse Practitioner	1111605	TX

General Provider Information

NPI Number	:	1881604395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES T. PARK APRN,FNP-C,DC

Provider Business Mailing Address
First Line	:	904 LEXINGTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3550
Country	:	US
Telephone Number	:	817-335-2666
Fax Number	:	817-335-2669

Provider Business Practice Location Address
First Line	:	904 LEXINGTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3550
Country	:	US
Telephone Number	:	817-335-2666
Fax Number	:	817-335-2669

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/08/2024

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