Provider Demographics
NPI:1972695203
Name:GALLAGHER, KARA THERESE (DC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:THERESE
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 1:6930 JOCKEY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2961
Mailing Address - Country:US
Mailing Address - Phone:703-753-8500
Mailing Address - Fax:
Practice Address - Street 1:6930 JOCKEY CLUB LN
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2961
Practice Address - Country:US
Practice Address - Phone:703-753-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU63359Medicare UPIN