Provider Demographics
NPI:1699196071
Name:GALLICK, ELIZABETH CARLISLE (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CARLISLE
Last Name:GALLICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-9001
Mailing Address - Country:US
Mailing Address - Phone:952-479-0043
Mailing Address - Fax:952-944-1673
Practice Address - Street 1:8577 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-9001
Practice Address - Country:US
Practice Address - Phone:952-479-0043
Practice Address - Fax:952-944-1673
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor