Provider Demographics
NPI:1225421779
Name:PALMER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:PALMER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-759-5036
Mailing Address - Street 1:1921 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4478
Mailing Address - Country:US
Mailing Address - Phone:231-777-2622
Mailing Address - Fax:
Practice Address - Street 1:1921 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4478
Practice Address - Country:US
Practice Address - Phone:231-777-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002646111N00000X
MI2301008027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP39340Medicare UPIN
MIT33298Medicare UPIN