Provider Demographics
NPI:1295961498
Name:PALMER, CHRISTOPHER MARK (AT,C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:PALMER
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1345
Mailing Address - Country:US
Mailing Address - Phone:651-270-6108
Mailing Address - Fax:
Practice Address - Street 1:2501 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1732
Practice Address - Country:US
Practice Address - Phone:952-927-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer