Provider Demographics
NPI:1528496270
Name:PALMER, MICHAEL ALAN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
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 1:2505 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4972
Mailing Address - Country:US
Mailing Address - Phone:505-425-9341
Mailing Address - Fax:505-672-7775
Practice Address - Street 1:100 CAMINO DE RON
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3257
Practice Address - Country:US
Practice Address - Phone:505-425-9341
Practice Address - Fax:505-425-9341
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2097111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor