Provider Demographics
NPI:1326629767
Name:PALMERTON, WILL (DC)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:PALMERTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2702
Mailing Address - Country:US
Mailing Address - Phone:863-258-4365
Mailing Address - Fax:
Practice Address - Street 1:3000 OPPORTUNITY CT STE B
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3474
Practice Address - Country:US
Practice Address - Phone:863-258-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty