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:F
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:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009584111N00000X
NJ38MC00607100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
20061613OtherAMERIHEALTH MERCY
PA1016259590002Medicaid
NJ070755XX3Medicare PIN
20061613OtherAMERIHEALTH MERCY
PA111918WQKMedicare PIN