Provider Demographics
NPI:1174720007
Name:PALMER CHIROPRATIC LLC
Entity type:Organization
Organization Name:PALMER CHIROPRATIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-567-4711
Mailing Address - Street 1:2501 27TH AVENUE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-1952
Mailing Address - Country:US
Mailing Address - Phone:772-567-4711
Mailing Address - Fax:772-567-4718
Practice Address - Street 1:2501 27TH AVENUE
Practice Address - Street 2:SUITE A-1
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-1952
Practice Address - Country:US
Practice Address - Phone:772-567-4711
Practice Address - Fax:772-567-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76031OtherBLUE CROSS BLUE SHIELD