MEDICARE: MR. CHRISTOPHER MARK PALMER A.T.,C.

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	2255A2300X	Athletic Trainer	1210	MN

General Provider Information

NPI Number	:	1295961498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MARK PALMER A.T.,C.

Provider Business Mailing Address
First Line	:	1053 WINSLOW AVE
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-1345
Country	:	US
Telephone Number	:	651-270-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 HIGHWAY 100 S
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1732
Country	:	US
Telephone Number	:	952-927-4176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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