Provider Demographics
NPI:1730592072
Name:CANYON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CANYON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-425-9341
Mailing Address - Street 1:2505 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4972
Mailing Address - Country:US
Mailing Address - Phone:505-425-9341
Mailing Address - Fax:505-672-7775
Practice Address - Street 1:2505 RIDGE RUNNER RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4972
Practice Address - Country:US
Practice Address - Phone:505-425-9341
Practice Address - Fax:505-672-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty