Provider Demographics
NPI:1730283219
Name:GALLOWAY, J ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:J ERIC
Middle Name:
Last Name:GALLOWAY
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:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-0643
Mailing Address - Country:US
Mailing Address - Phone:256-593-6363
Mailing Address - Fax:
Practice Address - Street 1:106 N MCCLESKEY ST
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1941
Practice Address - Country:US
Practice Address - Phone:256-593-6363
Practice Address - Fax:256-593-1965
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051031894OtherBLUE CROSS&BLUE SHIELD
AL51113379OtherBC AL
ALH347Medicare PIN
AL000031894Medicare ID - Type Unspecified
ALU64312Medicare UPIN
AL102G702504Medicare PIN