Provider Demographics
NPI:1780904193
Name:PALMER, TRACE THOMAS (DC)
Entity type:Individual
Prefix:
First Name:TRACE
Middle Name:THOMAS
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 1:11258 FORD AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8880
Mailing Address - Country:US
Mailing Address - Phone:912-756-3433
Mailing Address - Fax:866-625-0215
Practice Address - Street 1:11258 FORD AVE STE 13
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8880
Practice Address - Country:US
Practice Address - Phone:912-756-3433
Practice Address - Fax:866-625-0215
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007278111N00000X
MI2301007266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor