Provider Demographics
NPI:1255494357
Name:ANDRES GALEGO CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ANDRES GALEGO CHIROPRACTIC PC
Other - Org Name:ANDRES GALEGO DC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-564-0400
Mailing Address - Street 1:10401 OLD GEORGETOWN RD
Mailing Address - Street 2:STE 406 ANDRES GALEGO CHIROPRACTIC PC
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-564-0400
Mailing Address - Fax:301-493-4580
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:ANDRES GALEGO CHIROPRACTIC PC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-564-0400
Practice Address - Fax:301-493-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM081OtherCARE FIRST
DCS971OtherCARE FIRST
MD2004421OtherAETNA
751797Medicare ID - Type Unspecified
DC751797Medicare UPIN