Provider Demographics
NPI:1083891246
Name:PALOMBO, BRUCE WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIAM
Last Name:PALOMBO
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 1:264 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2532
Mailing Address - Country:US
Mailing Address - Phone:708-557-7000
Mailing Address - Fax:661-424-1422
Practice Address - Street 1:264 N WEST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2532
Practice Address - Country:US
Practice Address - Phone:708-557-7000
Practice Address - Fax:661-424-1422
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor