Provider Demographics
NPI:1295865699
Name:GALLOWAY, SUSAN ELLSWORTH (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELLSWORTH
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S BEDFORD ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3691
Mailing Address - Country:US
Mailing Address - Phone:608-257-1356
Mailing Address - Fax:
Practice Address - Street 1:301 S BEDFORD ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3691
Practice Address - Country:US
Practice Address - Phone:608-257-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2881012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor