Provider Demographics
NPI:1912071929
Name:PALAZZO, LAURA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:PALAZZO
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 1:18600 NORTHVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3544
Mailing Address - Country:US
Mailing Address - Phone:248-380-5680
Mailing Address - Fax:248-380-5681
Practice Address - Street 1:18600 NORTHVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:248-380-5680
Practice Address - Fax:248-380-5681
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV00069Medicare UPIN
MION92190Medicare ID - Type Unspecified