MEDICARE: BRONIA WALDEN PALMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC005904L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0700575000	OTHER	PA	BCBS
3	16936	OTHER	PA	HEALTH PARTNERS

General Provider Information

NPI Number	:	1295938421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRONIA WALDEN PALMER

Provider Business Mailing Address
First Line	:	3828 LOOP RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006
Country	:	US
Telephone Number	:	215-938-7324
Fax Number	:

Provider Business Practice Location Address
First Line	:	9548 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115
Country	:	US
Telephone Number	:	215-671-8860
Fax Number	:	215-671-8169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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Directions to “ BRONIA WALDEN PALMER ” Practice Location

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