Provider Demographics
NPI:1043324205
Name:GALL, KEVIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:GALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DEER PATH CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2048
Mailing Address - Country:US
Mailing Address - Phone:908-510-8051
Mailing Address - Fax:
Practice Address - Street 1:309 ROCK AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2616
Practice Address - Country:US
Practice Address - Phone:732-968-3900
Practice Address - Fax:732-968-3944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ541472OtherAETNA ID
NJP406638OtherINSURANCE ID OXFORD
NJ0454734000OtherAMERIHEALTH ID
NJ625109Medicare PIN
NJP406638OtherINSURANCE ID OXFORD