Provider Demographics
NPI:1154629079
Name:PALMER CHIROPRACTIC LIFE CENTER, INC
Entity Type:Organization
Organization Name:PALMER CHIROPRACTIC LIFE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-328-2656
Mailing Address - Street 1:191 CHRISTIANA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3024
Mailing Address - Country:US
Mailing Address - Phone:302-328-2656
Mailing Address - Fax:302-328-5870
Practice Address - Street 1:191 CHRISTIANA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3024
Practice Address - Country:US
Practice Address - Phone:302-328-2656
Practice Address - Fax:302-328-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
561525OtherMEDICARE