Provider Demographics
NPI:1467542340
Name:BIRDSLEY, GALEN C (DC)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:C
Last Name:BIRDSLEY
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 1:1360 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5336
Mailing Address - Country:US
Mailing Address - Phone:801-467-7141
Mailing Address - Fax:801-467-7246
Practice Address - Street 1:1360 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5336
Practice Address - Country:US
Practice Address - Phone:801-467-7141
Practice Address - Fax:801-467-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161813-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor