MEDICARE: DR. JEFFREY PALMER D.C.

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	DC 28993	CA

General Provider Information

NPI Number	:	1639109028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY PALMER D.C.

Provider Business Mailing Address
First Line	:	10628 RIVERSIDE DR
Second Line	:	SUITE # 5
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-508-6188
Fax Number	:	818-508-8405

Provider Business Practice Location Address
First Line	:	10628 RIVERSIDE DR
Second Line	:	SUITE # 5
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-508-6188
Fax Number	:	818-508-8405

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/28/2011

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