Provider Demographics
NPI:1275662447
Name:GALLENTINE, HEATH (DC)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:
Last Name:GALLENTINE
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 1:131 PROSPEROUS PL
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1853
Mailing Address - Country:US
Mailing Address - Phone:859-264-1140
Mailing Address - Fax:859-245-1190
Practice Address - Street 1:131 PROSPEROUS PL
Practice Address - Street 2:SUITE 15
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1853
Practice Address - Country:US
Practice Address - Phone:859-264-1140
Practice Address - Fax:859-245-1190
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY664708OtherUNITED HEALTHCARE ACN
KY770498OtherAETNA
KY7764195OtherCIGNA
KY000000352212OtherBLUE CROSS BLUE SHIELD
KY26-4779453OtherCHA
KY26-4779453OtherHUMANA
KY85002970Medicaid
KY3416485OtherAETNA HMO
KY7764195OtherCIGNA