Provider Demographics
NPI:1871877670
Name:GALLAGHER CHIROPRACTIC
Entity type:Organization
Organization Name:GALLAGHER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-795-4820
Mailing Address - Street 1:506 CROCKER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-9425
Mailing Address - Country:US
Mailing Address - Phone:608-795-4820
Mailing Address - Fax:608-795-4879
Practice Address - Street 1:506 CROCKER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:MAZOMANIE
Practice Address - State:WI
Practice Address - Zip Code:53560-9425
Practice Address - Country:US
Practice Address - Phone:608-795-4820
Practice Address - Fax:608-795-4879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALLAGHER CHIROPRACTIC S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3549-012261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU75515Medicare UPIN
WI35181Medicare PIN