Healthcare Provider Details

I. General information

NPI: 1477242543
Provider Name (Legal Business Name): PALMER REY PIANA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 THE PLACE BLVD
ESTERO FL
33928-6586
US

IV. Provider business mailing address

19441 THE PLACE BLVD
ESTERO FL
33928-6586
US

V. Phone/Fax

Practice location:
  • Phone: 860-733-3696
  • Fax:
Mailing address:
  • Phone: 860-733-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: