Provider Demographics
NPI:1144650862
Name:PARKS, AINSLEY LAUREL (DC)
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:LAUREL
Last Name:PARKS
Suffix:
Gender:F
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:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1121
Mailing Address - Country:US
Mailing Address - Phone:360-308-0930
Mailing Address - Fax:360-308-0937
Practice Address - Street 1:9220 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8556
Practice Address - Country:US
Practice Address - Phone:360-308-0930
Practice Address - Fax:360-308-0937
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32770111N00000X
OR5582111N00000X
WACH60629983111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor