Provider Demographics
NPI:1013948660
Name:GALLAGHER, BRETT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:DAVID
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 CREEMORE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-2095
Mailing Address - Country:US
Mailing Address - Phone:661-399-2062
Mailing Address - Fax:
Practice Address - Street 1:1665 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5023
Practice Address - Country:US
Practice Address - Phone:661-324-7724
Practice Address - Fax:661-324-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258700Medicare ID - Type Unspecified