Provider Demographics
NPI:1376690552
Name:PALMER, KIMBERLY O'BOYLE (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:O'BOYLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1309
Mailing Address - Country:US
Mailing Address - Phone:802-877-3567
Mailing Address - Fax:802-877-3567
Practice Address - Street 1:56 GREEN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1309
Practice Address - Country:US
Practice Address - Phone:802-877-3567
Practice Address - Fax:802-877-3567
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT03518525OtherBCBS PROVIDER NUMBER
VT03518525OtherBCBS PROVIDER NUMBER