Provider Demographics
NPI:1073092375
Name:YANG, PALMER LOR XIENG (DC)
Entity Type:Individual
Prefix:
First Name:PALMER
Middle Name:LOR XIENG
Last Name:YANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 RICE ST STE 112
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3721
Mailing Address - Country:US
Mailing Address - Phone:651-230-5526
Mailing Address - Fax:855-792-3260
Practice Address - Street 1:2345 RICE ST STE 128
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3720
Practice Address - Country:US
Practice Address - Phone:651-348-2338
Practice Address - Fax:855-792-3260
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor