NPIMap

Organization Active NPI

Palmer College Foundation

  • Chiropractor
  • Port Orange, FL
National Provider Identifier
1568552255
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PALMER COLLEGE FOUNDATION
Practice address
4705 S. Clyde Morris Blvd.
Port Orange, FL 32129
Phone
(386) 763-2718
Fax
(386) 763-2719
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tara Schulz
Title
Exec Director of Clinic Operations
Phone
(563) 884-5828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

4705 S. Clyde Morris Blvd.
Port Orange, FL 32129

Mailing address

1000 Brady St
Davenport, IA 52803-5214

Other identifiers 1

IdentifierTypeStateIssuer
74714OtherFLBCBS

Other names 1

  • Palmer College of Chiropractic Florida Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050823000300 FL Part B Supplier - Clinic/Group Practice 1557266863 Receives reassigned benefits from 30 practitioners
Practice locations: Port Orange, FL; Daytona Beach, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Invalid Entry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4705 Clyde Morris Blvd
Pt Orange, FL 32129
Phone (386) 763-2712

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 52

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1568552255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BRADY ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528035214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 S. CLYDE MORRIS BLVD.",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-763-2718",
            "fax_number": "386-763-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMER COLLEGE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "SCHULZ",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "EXEC DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "563-884-5828"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "74714",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmer College of Chiropractic Florida",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palmer College of Chiropractic Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.