=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205910742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE PALMER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 09/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7450 E PINNACLE PEAK RD #154
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-3435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-419-8900
-----------------------------------------------------
Fax | 480-419-9212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7450 E PINNACLE PEAK RD STE 154
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-419-8900
-----------------------------------------------------
Fax | 480-419-9212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7015
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------