Provider Demographics
NPI:1790748929
Name:GALLAGHER, SUSAN P (DIPLOMATE OM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DIPLOMATE OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9527 HURTY AVE
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9123
Mailing Address - Country:US
Mailing Address - Phone:720-261-1680
Mailing Address - Fax:
Practice Address - Street 1:8370 W COAL MINE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-4401
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO858171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist