MEDICARE: PARKER DOMINIQUE

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	111NS0005X	Sports Physician Chiropractor	33251	CA

General Provider Information

NPI Number	:	1922494509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARKER DOMINIQUE

Provider Business Mailing Address
First Line	:	2200 NE 26TH ST UNIT A
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-1538
Country	:	US
Telephone Number	:	305-450-7739
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 SW 71ST TER
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33317-7136
Country	:	US
Telephone Number	:	305-450-7739
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	07/11/2024

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Directions to “ PARKER DOMINIQUE ” Practice Location

Language	Start Address	Practice Location

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