Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 734 | CT |
NPI | 1326159096 |
---|---|
Provider Name | Terry Alan Palmer |
First Address | Naugatuck, CT 06770-2806 |
Second Address | Naugatuck, CT 06770-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004152279 | (05) | CT |
050000734CT01 | ANTHEM BLUE CROSS/BLUE SH (01) | CT |