Provider Demographics
NPI:1669425161
Name:GALVIN, GERALD J (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:GALVIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3267 LOWER SEGUIN RD LOWR SEGUIN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-4008
Mailing Address - Country:US
Mailing Address - Phone:210-658-6000
Mailing Address - Fax:210-658-6843
Practice Address - Street 1:8014 KITTY HAWK
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2424
Practice Address - Country:US
Practice Address - Phone:210-658-6000
Practice Address - Fax:210-658-6843
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN218170DMedicare PIN