Individual
DR. GLEN MICHAEL PALMISANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
633 LANDSHARK BLVD, DAYTONA BEACH, FL 32124-3727
(860) 585-9797
(860) 589-9002
Mailing address
633 LANDSHARK BLVD, DAYTONA BEACH, FL 32124-3727
(860) 751-8501
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
000681
CT
111N00000X
Chiropractor
CH5911
FL
111NR0400X
Rehabilitation Chiropractor
000681
CT
111NR0400X
Rehabilitation Chiropractor
Primary
5711
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050000681CT01
ANTHEM BCBS PROVIDER ID
CT
01
—
793437
CONNECTICARE PROVIDER ID
CT
Enumeration date
07/03/2006
Last updated
11/01/2024
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