Provider Demographics
NPI:1568536944
Name:PALMER, FRED J (DC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:J
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 1:6712 N MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3716
Mailing Address - Country:US
Mailing Address - Phone:847-673-8396
Mailing Address - Fax:
Practice Address - Street 1:6712 N MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3716
Practice Address - Country:US
Practice Address - Phone:847-673-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003831111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL628230Medicare ID - Type UnspecifiedMEDICARE
IL0001682365Medicare UPIN