Provider Demographics
NPI:1528029782
Name:GAGLIARDI, WILLIAM PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PETER
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:GAGLIARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 E CENTER ST STE 305
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5564
Mailing Address - Country:US
Mailing Address - Phone:801-430-9244
Mailing Address - Fax:801-304-3388
Practice Address - Street 1:37 E CENTER ST STE 305
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5564
Practice Address - Country:US
Practice Address - Phone:801-430-9244
Practice Address - Fax:801-304-3388
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60929450111N00000X
PADC005874L111N00000X
UT10501915-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10501915-1202OtherSTATE ID
PADC005874LOtherSTATE ID
PAU65809OtherUPIN
WACH60929450OtherSTATE ID