Provider Demographics
NPI:1205910742
Name:PALMER, KYLE (DC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
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 1:7450 E PINNACLE PEAK RD STE 154
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3605
Mailing Address - Country:US
Mailing Address - Phone:480-419-8900
Mailing Address - Fax:480-419-9212
Practice Address - Street 1:7450 E PINNACLE PEAK RD
Practice Address - Street 2:#154
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3435
Practice Address - Country:US
Practice Address - Phone:480-419-8900
Practice Address - Fax:480-419-9212
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628240OtherACN PROVIDER ID
AZ7418290OtherAETNA ID
AZAZ0931770OtherBLUE CROSS BLUE SHIELD ID
AZAZ0931770OtherBLUE CROSS BLUE SHIELD ID