Provider Demographics
NPI:1043242407
Name:GALLAGHER, NANCY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:GALLAGHER
Suffix:
Gender:
Credentials:DC
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:WILLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:143 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1123
Mailing Address - Country:US
Mailing Address - Phone:973-398-1800
Mailing Address - Fax:973-398-3770
Practice Address - Street 1:143 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1123
Practice Address - Country:US
Practice Address - Phone:973-398-1800
Practice Address - Fax:973-398-3770
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00607100111N00000X
NJ18KT01382000225700000X
PADC009584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016259590002Medicaid
20061613OtherAMERIHEALTH MERCY
NJ070755XX3Medicare PIN
20061613OtherAMERIHEALTH MERCY
PA111918WQKMedicare PIN