Provider Demographics
NPI:1558329409
Name:PALMER, MICHELLE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:WICKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1217 HOLLAND SQ
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7861
Mailing Address - Country:US
Mailing Address - Phone:402-312-1999
Mailing Address - Fax:660-829-2607
Practice Address - Street 1:910 THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2241
Practice Address - Country:US
Practice Address - Phone:660-829-2600
Practice Address - Fax:660-829-2607
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1354111N00000X
MO2008022535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280296Medicare UPIN