Provider Demographics
NPI:1497841175
Name:PALMER, GARY E (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:PALMER
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 1:723 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750
Mailing Address - Country:US
Mailing Address - Phone:405-375-5497
Mailing Address - Fax:405-375-5485
Practice Address - Street 1:723 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750
Practice Address - Country:US
Practice Address - Phone:405-375-5497
Practice Address - Fax:405-375-5485
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1049908OtherEMPLOYER TAX ID NUMBER
OKQDBVTMedicare ID - Type Unspecified
OKT-79992Medicare UPIN