Provider Demographics
NPI:1699035964
Name:THE CHIROPRACTIC PALMS PC
Entity Type:Organization
Organization Name:THE CHIROPRACTIC PALMS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-268-4277
Mailing Address - Street 1:302 REDFERN VLG
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2537
Mailing Address - Country:US
Mailing Address - Phone:912-268-4277
Mailing Address - Fax:912-268-4289
Practice Address - Street 1:302 REDFERN VLG
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2537
Practice Address - Country:US
Practice Address - Phone:912-268-4277
Practice Address - Fax:912-268-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty