Provider Demographics
NPI:1518578137
Name:PALMERCARE CHIROPRACTIC FAIRFAX CITY, INC
Entity Type:Organization
Organization Name:PALMERCARE CHIROPRACTIC FAIRFAX CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-829-7506
Mailing Address - Street 1:3970 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4726
Mailing Address - Country:US
Mailing Address - Phone:703-421-2990
Mailing Address - Fax:703-421-2822
Practice Address - Street 1:3970 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4726
Practice Address - Country:US
Practice Address - Phone:703-421-2990
Practice Address - Fax:703-421-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty