Provider Demographics
NPI:1851837785
Name:DUSTIN PALMER BODYWORK & MASSAGE, LLC.
Entity Type:Organization
Organization Name:DUSTIN PALMER BODYWORK & MASSAGE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:DREESE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:248-632-4728
Mailing Address - Street 1:26789 WOODWARD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1334
Mailing Address - Country:US
Mailing Address - Phone:248-631-4728
Mailing Address - Fax:248-282-0358
Practice Address - Street 1:26789 WOODWARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:248-631-4728
Practice Address - Fax:248-282-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty