Basic Information
| Provider Information | |||||||||
| NPI: | 1427055367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALAZZO | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE B | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027735600 | ||||||||
| FaxNumber: | 6027735601 | ||||||||
| Practice Location | |||||||||
| Address1: | 12020 S WARNER ELLIOT LOOP | ||||||||
| Address2: | STE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850442700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027735600 | ||||||||
| FaxNumber: | 6027735600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5857 | AZ | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | AZ0943260 | 01 | AZ | BCBS OF ARIZONA | OTHER | 447088 | 05 | AZ | MEDICAID | 7887069 | 01 | AZ | AETNA | OTHER |