Provider Demographics
NPI:1518041383
Name:GALLO, CARLO (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:
Last Name:GALLO
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 1:1323 BUTTERFIELD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5620
Mailing Address - Country:US
Mailing Address - Phone:630-407-0100
Mailing Address - Fax:630-407-0300
Practice Address - Street 1:1323 BUTTERFIELD RD STE 108
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5620
Practice Address - Country:US
Practice Address - Phone:630-407-0100
Practice Address - Fax:630-407-0300
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL035009957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206877Medicare ID - Type Unspecified
ILU99736Medicare UPIN