Provider Demographics
NPI:1447333448
Name:PALM CHIROPRACTIC & WELLNESS INC
Entity type:Organization
Organization Name:PALM CHIROPRACTIC & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, V.P., TREASURER, SECRETAR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-741-8739
Mailing Address - Street 1:5220 4TH AVENUE CIRCLE EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-741-8739
Mailing Address - Fax:941-803-8319
Practice Address - Street 1:5220 4TH AVENUE CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-741-8739
Practice Address - Fax:941-803-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID NUMBER