Provider Demographics
NPI:1912041187
Name:GALLAGHER, AGNES M (DC)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 PITTSBURGH RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-8958
Mailing Address - Country:US
Mailing Address - Phone:724-586-9777
Mailing Address - Fax:
Practice Address - Street 1:890 PITTSBURGH RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-8958
Practice Address - Country:US
Practice Address - Phone:724-586-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003839L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA538556OtherHIGHMARK