Provider Demographics
NPI:1669085023
Name:GALLUCCI, LAUREN T (DC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:GALLUCCI
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 1:1337 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1823
Mailing Address - Country:US
Mailing Address - Phone:401-831-0900
Mailing Address - Fax:401-272-3157
Practice Address - Street 1:1337 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1823
Practice Address - Country:US
Practice Address - Phone:401-831-0900
Practice Address - Fax:401-272-3157
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP000678111N00000X
RIDCP00678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor