Healthcare Provider Details

I. General information

NPI: 1659549087
Provider Name (Legal Business Name): PALERMO CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W 19TH ST
HAZLETON PA
18201-1807
US

IV. Provider business mailing address

317 W 19TH ST
HAZLETON PA
18201-1807
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-1110
  • Fax:
Mailing address:
  • Phone: 570-459-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002759L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL A PALERMO
Title or Position: OWNER
Credential: D.C.
Phone: 570-459-1110