Provider Demographics
NPI:1710951850
Name:PALMER, RICK
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651
Mailing Address - Country:US
Mailing Address - Phone:319-342-2760
Mailing Address - Fax:319-342-2760
Practice Address - Street 1:801 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651
Practice Address - Country:US
Practice Address - Phone:319-342-2760
Practice Address - Fax:319-342-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0023416Medicaid
IA02341Medicare PIN
T00291Medicare UPIN