Provider Demographics
NPI:1114685971
Name:PALKOVITS-STAUBER, KAREN BJ (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BJ
Last Name:PALKOVITS-STAUBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 6TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2564
Mailing Address - Country:US
Mailing Address - Phone:310-740-6419
Mailing Address - Fax:
Practice Address - Street 1:1515 PALISADES DR STE N3
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2174
Practice Address - Country:US
Practice Address - Phone:310-740-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor