Provider Demographics
NPI:1871841700
Name:GALLUCCI CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GALLUCCI CHIROPRACTIC, LLC
Other - Org Name:CHOICE CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-424-0019
Mailing Address - Street 1:993 BRODHEAD RD STE 50
Mailing Address - Street 2:
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2331
Mailing Address - Country:US
Mailing Address - Phone:412-424-0019
Mailing Address - Fax:412-424-0022
Practice Address - Street 1:993 BRODHEAD RD STE 50
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2331
Practice Address - Country:US
Practice Address - Phone:412-424-0019
Practice Address - Fax:412-424-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023676070001Medicaid