Provider Demographics
NPI:1417030024
Name:PALMER COLLEGE OF CHIROPRACTIC WEST
Entity Type:Organization
Organization Name:PALMER COLLEGE OF CHIROPRACTIC WEST
Other - Org Name:PALMER COLLEGE OF CHIROPRACTIC WEST, PALMER CHIROPRACTIC UNIV. FOUND.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DEAN OF CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-884-5567
Mailing Address - Street 1:1000 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5214
Mailing Address - Country:US
Mailing Address - Phone:563-888-5810
Mailing Address - Fax:563-884-5470
Practice Address - Street 1:90 E TASMAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134
Practice Address - Country:US
Practice Address - Phone:408-944-6000
Practice Address - Fax:408-944-6102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMER COLLEGE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13402ZMedicare PIN