Provider Demographics
NPI:1245365733
Name:PALMER COLLEGE FOUNDATION
Entity type:Organization
Organization Name:PALMER COLLEGE FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-884-5828
Mailing Address - Street 1:2001 52ND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6368
Mailing Address - Country:US
Mailing Address - Phone:309-764-4901
Mailing Address - Fax:309-797-7688
Practice Address - Street 1:2001 52ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6368
Practice Address - Country:US
Practice Address - Phone:309-764-4901
Practice Address - Fax:309-797-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038003364Medicaid
IL038003521Medicaid
IL038008298Medicaid
IL038005059Medicaid
IL038009444Medicaid
IL0008115279OtherBLUE CROSS BLUE SHIELD IL
=========OtherTAX IDENTIFICATION
IL038003364Medicaid