Provider Demographics
NPI:1295938421
Name:WALDEN PALMER, BRONIA
Entity type:Individual
Prefix:
First Name:BRONIA
Middle Name:
Last Name:WALDEN PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-938-7324
Mailing Address - Fax:
Practice Address - Street 1:9548 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-671-8860
Practice Address - Fax:215-671-8169
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005904L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015116230002Medicaid
PA0700575000OtherBCBS
PA16936OtherHEALTH PARTNERS
PA16936OtherHEALTH PARTNERS
16936Medicare UPIN