Provider Demographics
NPI:1295727451
Name:PALERMO, MICHAEL A (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:PALERMO
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 1:1730 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5657
Mailing Address - Country:US
Mailing Address - Phone:570-497-4150
Mailing Address - Fax:570-497-4151
Practice Address - Street 1:1730 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5657
Practice Address - Country:US
Practice Address - Phone:570-497-4150
Practice Address - Fax:570-497-4151
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002759L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0974175Medicaid
PAT29250Medicare UPIN
PA120957Medicare ID - Type Unspecified