Provider Demographics
NPI:1518238575
Name:KEVIN M. GALLAGHER D.C. P.A.
Entity Type:Organization
Organization Name:KEVIN M. GALLAGHER D.C. P.A.
Other - Org Name:PALM HARBOR CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-789-0800
Mailing Address - Street 1:550 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4431
Mailing Address - Country:US
Mailing Address - Phone:727-789-0800
Mailing Address - Fax:727-787-0862
Practice Address - Street 1:550 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4431
Practice Address - Country:US
Practice Address - Phone:727-789-0800
Practice Address - Fax:727-787-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty