Provider Demographics
NPI:1326491457
Name:PALMER, MARISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:PALMER
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 1:20687 AMAR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13677 FOOTHILL BLVD
Practice Address - Street 2:STE P
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0214
Practice Address - Country:US
Practice Address - Phone:909-766-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor