Provider Demographics
NPI:1598097529
Name:GALT, MAX STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:STEPHEN
Last Name:GALT
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 1:1401 NORTH COURT STREET
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:618-993-7500
Mailing Address - Fax:618-993-0122
Practice Address - Street 1:1401 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-993-7500
Practice Address - Fax:618-993-0122
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor