Provider Demographics
NPI:1730320383
Name:COLLEEN P. GALLAGHER, DC, A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:COLLEEN P. GALLAGHER, DC, A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:DISCOVER HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-225-6111
Mailing Address - Street 1:17145 VON KARMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0907
Mailing Address - Country:US
Mailing Address - Phone:949-225-6111
Mailing Address - Fax:949-225-6114
Practice Address - Street 1:17145 VON KARMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-0907
Practice Address - Country:US
Practice Address - Phone:949-225-6111
Practice Address - Fax:949-225-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29969261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center