Active NPI
Glen Michael Palmisano, DC
- Rehabilitation Chiropractor
- Daytona Beach, FL
National Provider Identifier
1255360855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 5711
- Practice address
- 633 Landshark Blvd
Daytona Beach, FL 32124-3727 - Phone
- (860) 585-9797
- Fax
- (860) 589-9002
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH5911 | FL | |
| Chiropractor | 111N00000X | 000681 | CT | |
| Rehabilitation Chiropractor | 111NR0400X | 000681 | CT | |
| Rehabilitation Chiropractor | 111NR0400X | 5711 | FL | Primary |
Addresses
Primary practice location
633 Landshark Blvd
Daytona Beach, FL 32124-3727
Mailing address
633 Landshark Blvd
Daytona Beach, FL 32124-3727
Phone (860) 751-8501
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050000681CT01 | Other | CT | ANTHEM BCBS PROVIDER ID |
| 793437 | Other | CT | CONNECTICARE PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH5911 | FL | MD | Chiropractor |
| 000681 | CT | MD | Rehabilitation Chiropractor |
| 5711 | FL | MD | Rehabilitation Chiropractor |
Interoperability endpoints
- doc1@bcai0001.direct.chirotouch.md
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730419200000",
"number": "1255360855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 LANDSHARK BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321243727",
"telephone_number": "860-751-8501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 LANDSHARK BLVD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321243727",
"telephone_number": "860-585-9797",
"fax_number": "860-589-9002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMISANO",
"first_name": "GLEN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2024-11-01",
"certification_date": "2024-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH5911",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CT",
"license": "000681",
"primary": false
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "CT",
"license": "000681",
"primary": false
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "FL",
"license": "5711",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS PROVIDER ID",
"identifier": "050000681CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE PROVIDER ID",
"identifier": "793437",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.