1154629079 NPI number — PALMER CHIROPRACTIC LIFE CENTER, INC

Table of content: (NPI 1154629079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154629079 NPI number — PALMER CHIROPRACTIC LIFE CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMER CHIROPRACTIC LIFE CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154629079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PLEASANT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-328-2656
Provider Business Mailing Address Fax Number:
302-328-5870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PLEASANT PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-328-2656
Provider Business Practice Location Address Fax Number:
302-328-5870
Provider Enumeration Date:
03/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PALMER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-328-2656

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  F1-0000268 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154629079 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1598812067 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 561525 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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