Provider Demographics
NPI:1023673068
Name:GALLAGHER, JACK EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EDWARD
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 1:7200 W 141ST ST APT 2501
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3978
Mailing Address - Country:US
Mailing Address - Phone:231-409-1555
Mailing Address - Fax:
Practice Address - Street 1:7707 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3138
Practice Address - Country:US
Practice Address - Phone:502-962-2277
Practice Address - Fax:502-962-1001
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263347111N00000X
KS01-05974111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation