Provider Demographics
NPI:1083340434
Name:PALMERCARE CHIROPRACTIC FORT WORTH LLC
Entity Type:Organization
Organization Name:PALMERCARE CHIROPRACTIC FORT WORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-829-7506
Mailing Address - Street 1:46169 WESTLAKE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5875
Mailing Address - Country:US
Mailing Address - Phone:713-829-7506
Mailing Address - Fax:
Practice Address - Street 1:126 S MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1209
Practice Address - Country:US
Practice Address - Phone:817-935-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty