Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 000681 | CT |
N | 111N00000X | Chiropractor | CH5911 | FL |
Y | 111NR0400X | Rehabilitation Chiropractor | 000681 | CT |
NPI | 1255360855 |
---|---|
Provider Name | Dr. Glen Michael Palmisano |
First Address | Bristol, CT 06010-6505 |
Second Address | Bristol, CT 06010-6505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 29/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050000681CT01 | ANTHEM BCBS PROVIDER ID (01) | CT |
793437 | CONNECTICARE PROVIDER ID (01) | CT |
T90504 | (02) | CT |