Provider Demographics
NPI:1962446922
Name:PALUMBO, MIKE JR (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:PALUMBO
Suffix:JR
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S BROAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3948
Mailing Address - Country:US
Mailing Address - Phone:215-952-6931
Mailing Address - Fax:215-952-6933
Practice Address - Street 1:2222 S BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3948
Practice Address - Country:US
Practice Address - Phone:215-952-6931
Practice Address - Fax:215-952-6933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006801L111N00000X
DEF1-0000417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA78747738OtherCIGNA
PA01723349Medicaid
PA1050891OtherAETNA
PA78747738OtherCIGNA
PAU61870Medicare UPIN