1457438798 NPI number — PALMER CHIROPRACTIC CENTER, INC.

Table of content: (NPI 1457438798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457438798 NPI number — PALMER CHIROPRACTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMER CHIROPRACTIC 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:
1457438798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 7TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ALTAVISTA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24517-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-369-1015
Provider Business Mailing Address Fax Number:
434-369-1017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 7TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALTAVISTA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24517-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-369-1015
Provider Business Practice Location Address Fax Number:
434-369-1017
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMER
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
WOOD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-369-1015

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104001965 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023195302 . This is a "INDIVIDUAL NPI ADAM W. PALMER, D.C." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 440426 . This is a "ANTHEM ALTAVISTA PALMER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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