Provider Demographics
NPI:1326266909
Name:GALLAGHER, JUDITH MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARIA
Last Name:GALLAGHER
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 1:12 DARTMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6133
Mailing Address - Country:US
Mailing Address - Phone:401-781-1102
Mailing Address - Fax:
Practice Address - Street 1:1040 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2615
Practice Address - Country:US
Practice Address - Phone:401-944-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIDC334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31731-5OtherBCBS
RI31731-5OtherBCBS