Provider Demographics
NPI:1255992814
Name:WAYNE PALMER DC PA
Entity type:Organization
Organization Name:WAYNE PALMER DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-220-5880
Mailing Address - Street 1:3500 SW CORPORATE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8185
Mailing Address - Country:US
Mailing Address - Phone:772-220-5880
Mailing Address - Fax:772-220-5888
Practice Address - Street 1:3500 SW CORPORATE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8185
Practice Address - Country:US
Practice Address - Phone:772-220-5880
Practice Address - Fax:772-220-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE PALMER DC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty