Provider Demographics
NPI:1225234206
Name:ALLERGY AND ASTHMA CARECENTER SC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CARECENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-672-3158
Mailing Address - Street 1:120 NE GLEN OAK AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4314
Mailing Address - Country:US
Mailing Address - Phone:309-672-3158
Mailing Address - Fax:309-672-3114
Practice Address - Street 1:120 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4314
Practice Address - Country:US
Practice Address - Phone:309-672-3158
Practice Address - Fax:309-672-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.007061036.047262261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center