Provider Demographics
NPI:1194835371
Name:GALLO, JAMES PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PETER
Last Name:GALLO
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 1:10237 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3939
Mailing Address - Country:US
Mailing Address - Phone:954-752-2415
Mailing Address - Fax:954-752-9649
Practice Address - Street 1:10237 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3939
Practice Address - Country:US
Practice Address - Phone:954-752-2415
Practice Address - Fax:954-752-9649
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT56124Medicare UPIN
FL89180Medicare ID - Type Unspecified