Provider Demographics
NPI:1568437705
Name:GALLAGHER, DEAN ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ROGER
Last Name:GALLAGHER
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 1:934 HWY 36
Mailing Address - Street 2:
Mailing Address - City:LEONARDO
Mailing Address - State:NJ
Mailing Address - Zip Code:07737-1709
Mailing Address - Country:US
Mailing Address - Phone:732-291-5656
Mailing Address - Fax:732-291-9334
Practice Address - Street 1:934 HWY 36
Practice Address - Street 2:
Practice Address - City:LEONARDO
Practice Address - State:NJ
Practice Address - Zip Code:07737-1709
Practice Address - Country:US
Practice Address - Phone:732-291-5656
Practice Address - Fax:732-291-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451243Medicare ID - Type Unspecified