Provider Demographics
NPI:1194911834
Name:ROSS PALAZZOLO CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:ROSS PALAZZOLO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-659-4442
Mailing Address - Street 1:811 MYRTLE TER
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2814
Mailing Address - Country:US
Mailing Address - Phone:239-659-4442
Mailing Address - Fax:239-659-4445
Practice Address - Street 1:811 MYRTLE TER
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2814
Practice Address - Country:US
Practice Address - Phone:239-659-4442
Practice Address - Fax:239-659-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1427110592OtherMEDICARE NPI
FL70722OtherBLUE CROSS BLUE SHIELD