Provider Demographics
NPI:1174968390
Name:PARKS, CLIFFORD KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:KYLE
Last Name:PARKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1225
Mailing Address - Country:US
Mailing Address - Phone:610-367-7850
Mailing Address - Fax:610-367-2820
Practice Address - Street 1:500 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1225
Practice Address - Country:US
Practice Address - Phone:610-367-7850
Practice Address - Fax:610-367-2820
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor