Provider Demographics
NPI:1740418771
Name:PALMER, JASON ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANTHONY
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 1:1235 INDIANA CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4540
Mailing Address - Country:US
Mailing Address - Phone:909-793-4515
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIANA CT
Practice Address - Street 2:SUITE 105
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4540
Practice Address - Country:US
Practice Address - Phone:909-793-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30254111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor