Provider Demographics
NPI:1053633156
Name:GALLOWAY PAIN CARE CENTER INC
Entity Type:Organization
Organization Name:GALLOWAY PAIN CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-595-3533
Mailing Address - Street 1:9300 GALLOWAY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2413
Mailing Address - Country:US
Mailing Address - Phone:305-595-3533
Mailing Address - Fax:305-595-3551
Practice Address - Street 1:9300 GALLOWAY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2413
Practice Address - Country:US
Practice Address - Phone:305-595-3533
Practice Address - Fax:305-595-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2167171100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP123OtherACUPUNCTURIST
FL2167OtherHEALTH CARE CLINIC EXEMPTION
FLMA45463OtherMASSAGE THERAPIST