MEDICARE: DR. ANTHONY J PALOMBO D.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	111NN1001X	Nutrition Chiropractor	181	LA

General Provider Information

NPI Number	:	1578620662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY J PALOMBO D.C.

Provider Business Mailing Address
First Line	:	805 BAYOU PINES WEST DRIVE
Second Line	:	SUITE A
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-9605
Country	:	US
Telephone Number	:	337-437-3991
Fax Number	:	337-437-3958

Provider Business Practice Location Address
First Line	:	805 BAYOU PINES WEST DRIVE
Second Line	:	SUITE A
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-9605
Country	:	US
Telephone Number	:	337-437-3991
Fax Number	:	337-437-3958

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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