Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-003831 | IL |
NPI | 1568536944 |
---|---|
Provider Name | Fred J Palmer |
First Address | Lincolnwood, IL 60712-3716 |
Second Address | Lincolnwood, IL 60712-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001682365 | (02) | IL |