Provider Demographics
NPI:1609073733
Name:GALLAGHER, STEPHEN J (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
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 1:9100 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2020
Mailing Address - Country:US
Mailing Address - Phone:708-430-9999
Mailing Address - Fax:708-430-9057
Practice Address - Street 1:9100 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2020
Practice Address - Country:US
Practice Address - Phone:708-430-9999
Practice Address - Fax:708-430-9057
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31623170OtherBLUE CROSSBLUE SHIELD
K49504Medicare PIN
IL31623170OtherBLUE CROSSBLUE SHIELD