Active NPI
Parker Dominique
- Sports Physician Chiropractor
- Davie, FL
National Provider Identifier
1922494509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 33251
- Practice address
- 2250 SW 71St Ter
Davie, FL 33317-7136 - Phone
- (305) 450-7739
- NPI assigned
- Apr 10, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 33251 | CA | Primary |
Addresses
Primary practice location
2250 SW 71St Ter
Davie, FL 33317-7136
Mailing address
2200 NE 26TH St Unit a
Wilton Manors, FL 33305-1538
Phone (305) 450-7739
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33251 | CA | MD | Geriatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prism Chiropractic and Wellness Center, L.L.C. | Sports Physician | Current | Accepting new patients |
Locations
2250 SW 71st Ter
Davie, FL 33317
Phone (954) 806-5896
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Sports Physician Chiropractor
- Davie, FL
- NPI 1881437978
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720656000000",
"number": "1922494509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 NE 26TH ST UNIT A",
"city": "WILTON MANORS",
"state": "FL",
"postal_code": "333051538",
"telephone_number": "305-450-7739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 SW 71ST TER",
"city": "DAVIE",
"state": "FL",
"postal_code": "333177136",
"telephone_number": "305-450-7739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINIQUE",
"first_name": "PARKER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-10",
"last_updated": "2024-07-11",
"certification_date": "2024-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CA",
"license": "33251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.