MEDICARE: CHYPHES 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	171400000X	Health & Wellness Coach
2	225700000X	Massage Therapist	08955	NC

General Provider Information

NPI Number	:	1497411243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHYPHES PALMER

Provider Business Mailing Address
First Line	:	13102 GREAT LAUREL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-3689
Country	:	US
Telephone Number	:	704-340-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4822 ALBEMARLE RD STE 110A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6612
Country	:	US
Telephone Number	:	704-769-0251
Fax Number	:

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

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	11/16/2021

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Directions to “ CHYPHES PALMER ” Practice Location

Language	Start Address	Practice Location

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