Healthcare Provider Details

I. General information

NPI: 1477533636
Provider Name (Legal Business Name): LISA ANN PALMER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 W SR 436 SUITE NUMBER 1020
ALTAMONTE SPRINGS FL
32714-2936
US

IV. Provider business mailing address

52 DAHLIA DR
DEBARY FL
32713-2816
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-8444
  • Fax:
Mailing address:
  • Phone: 407-310-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH8943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: