Provider Demographics
NPI:1639396963
Name:GALLEGOS, CHRIS R (DOM)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:R
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35388
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5388
Mailing Address - Country:US
Mailing Address - Phone:505-363-4386
Mailing Address - Fax:505-559-4764
Practice Address - Street 1:6013 AZURE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2626
Practice Address - Country:US
Practice Address - Phone:505-363-4386
Practice Address - Fax:505-559-4764
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist