Provider Demographics
NPI:1942352109
Name:GANLEY, MARY PATRICIA (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:GANLEY
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 1:3470 HAMPTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1936
Mailing Address - Country:US
Mailing Address - Phone:314-352-6608
Mailing Address - Fax:
Practice Address - Street 1:3470 HAMPTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1936
Practice Address - Country:US
Practice Address - Phone:314-352-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor