Provider Demographics
NPI:1861461931
Name:GALLAGHER, JOHN HUGH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUGH
Last Name:GALLAGHER
Suffix:JR
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 1:2222 TRENTON RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1400
Mailing Address - Country:US
Mailing Address - Phone:215-949-2202
Mailing Address - Fax:215-757-3511
Practice Address - Street 1:2222 TRENTON RD STE 1B
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1400
Practice Address - Country:US
Practice Address - Phone:215-949-2202
Practice Address - Fax:215-757-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002479L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007051235Medicaid
PAGA118105OtherHIGHMARK BLUE SHIELD
PA0023309000OtherINDEPENDENCE BLUE CROSS
PAT29213Medicare UPIN
PA0007051235Medicaid