Provider Demographics
NPI:1518077932
Name:GALLAGHER, PATRICK A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:GALLAGHER
Suffix:JR
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 1:6800 78TH AVE N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2758
Mailing Address - Country:US
Mailing Address - Phone:763-566-1042
Mailing Address - Fax:763-566-8090
Practice Address - Street 1:6800 78TH AVE N
Practice Address - Street 2:SUITE 107
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2758
Practice Address - Country:US
Practice Address - Phone:763-566-1042
Practice Address - Fax:763-566-8090
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39824Medicare UPIN