Provider Demographics
NPI:1851661037
Name:GALT CHIROPRACTIC OFFICE, INC.
Entity Type:Organization
Organization Name:GALT CHIROPRACTIC OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-565-8122
Mailing Address - Street 1:3305 NE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7109
Mailing Address - Country:US
Mailing Address - Phone:954-565-8122
Mailing Address - Fax:954-565-4304
Practice Address - Street 1:3305 NE 33RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7109
Practice Address - Country:US
Practice Address - Phone:954-565-8122
Practice Address - Fax:954-565-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty