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General NPI Number Information
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NPI Number | 1255360855
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Entity Type | Individual
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Provider Name | GLEN MICHAEL PALMISANO DC
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 633 LANDSHARK BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-3727
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Country | US
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Telephone | 860-585-9797
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Fax | 860-589-9002
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Provider Business Mailing Address
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Address Line | 633 LANDSHARK BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-3727
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Country | US
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Telephone | 860-751-8501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH5911
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 000681
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 000681
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 5711
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License Number State | FL
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