Provider Demographics
NPI:1972597623
Name:PALMER, BRYCE A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:A
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 1:4400 SERGEANT RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4740
Mailing Address - Country:US
Mailing Address - Phone:712-274-6202
Mailing Address - Fax:712-274-1198
Practice Address - Street 1:4400 SERGEANT RD
Practice Address - Street 2:SUITE 216
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4740
Practice Address - Country:US
Practice Address - Phone:712-274-6202
Practice Address - Fax:712-274-1198
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6094111N00000X
IA007155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811483Medicare PIN
COV06706Medicare UPIN