MEDICARE: PALMERCARE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1124356456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMERCARE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	46169 WESTLAKE DR STE 300
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	46169 WESTLAKE DR STE 300
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-421-2990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COREY MALNIKOF
Credential	:
Telephone Number	:	703-421-2990

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2021

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