Provider Demographics
NPI:1750858486
Name:PALMERCARE CHIROPRACTIC LOVETTSVILLE LLC
Entity Type:Organization
Organization Name:PALMERCARE CHIROPRACTIC LOVETTSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-829-7506
Mailing Address - Street 1:20 TOWN SQ UNIT 130
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180-8556
Mailing Address - Country:US
Mailing Address - Phone:571-264-0643
Mailing Address - Fax:
Practice Address - Street 1:20 TOWN SQ UNIT 130
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180-8556
Practice Address - Country:US
Practice Address - Phone:571-264-0643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556191OtherLICENSE