Provider Demographics
NPI:1639109028
Name:PALMER, JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:10628 RIVERSIDE DR
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2373
Mailing Address - Country:US
Mailing Address - Phone:818-508-6188
Mailing Address - Fax:818-508-8405
Practice Address - Street 1:10628 RIVERSIDE DR
Practice Address - Street 2:SUITE # 5
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2373
Practice Address - Country:US
Practice Address - Phone:818-508-6188
Practice Address - Fax:818-508-8405
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor