Provider Demographics
NPI:1073703351
Name:PALM, MARTHA FRITH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:FRITH
Last Name:PALM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:BASKIN FRITH
Other - Last Name:PALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 ERICA COURT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-1900
Mailing Address - Country:US
Mailing Address - Phone:415-898-1699
Mailing Address - Fax:415-899-8013
Practice Address - Street 1:14 ERICA COURT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-1900
Practice Address - Country:US
Practice Address - Phone:415-898-1699
Practice Address - Fax:415-899-8013
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA15207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15207OtherLICENSE NUMBER