=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922134824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY PALMER DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 05/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 W SOUTH AVE
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49421-9702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-854-1455
-----------------------------------------------------
Fax | 231-854-0299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 W SOUTH AVE
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49421-9702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-854-1455
-----------------------------------------------------
Fax | 231-854-0299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAMIAN AARON PALMER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 231-854-1455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DP007201
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------