Provider Demographics
NPI:1457434995
Name:PALMER, WAYNE P (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:P
Last Name:PALMER
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 1:113 PRESLEY WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5800
Mailing Address - Country:US
Mailing Address - Phone:530-273-0274
Mailing Address - Fax:530-273-0275
Practice Address - Street 1:113 PRESLEY WAY STE 11
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5800
Practice Address - Country:US
Practice Address - Phone:530-273-0274
Practice Address - Fax:530-273-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6578734OtherMEDI-CAL
CA14184OtherLICENSE
CA6578734OtherMEDI-CAL
CAT05276Medicare UPIN