Provider Demographics
NPI:1659426625
Name:KATHLEEN M GALLIGAN
Entity Type:Organization
Organization Name:KATHLEEN M GALLIGAN
Other - Org Name:KRUSE PARK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-635-1236
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3480
Mailing Address - Country:US
Mailing Address - Phone:503-635-1236
Mailing Address - Fax:503-597-4741
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:SUITE #201
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3480
Practice Address - Country:US
Practice Address - Phone:503-635-1236
Practice Address - Fax:503-597-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109099Medicare ID - Type Unspecified