Provider Demographics
NPI:1487633608
Name:GALLOWAY, NICHOLAS J II (DC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:GALLOWAY
Suffix:II
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 1:510 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4705
Mailing Address - Country:US
Mailing Address - Phone:214-943-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1439
Practice Address - Country:US
Practice Address - Phone:214-943-9431
Practice Address - Fax:214-943-9407
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P2241OtherBCBS
TX8P5602OtherBCBS
TX8U3300OtherBCBS
TX8M8881OtherBCBS
TX8M8881OtherBCBS
TX8P5602OtherBCBS
TX8C6630Medicare ID - Type Unspecified
TX8F1894Medicare ID - Type Unspecified
TX8C7425Medicare ID - Type Unspecified