Provider Demographics
NPI:1952324683
Name:GALLAGHER, BRIANNE KRISTA (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:KRISTA
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 1:211 EDDIE CHASTEEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488
Mailing Address - Country:US
Mailing Address - Phone:952-240-2891
Mailing Address - Fax:
Practice Address - Street 1:386 OAK ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3034
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300P7GAOtherBLUECROSS BLUESHIELD MN
MNV07611Medicare UPIN
MN300P7GAOtherBLUECROSS BLUESHIELD MN