Provider Demographics
NPI:1801051669
Name:ANDREA K GALE DC, LLC
Entity type:Organization
Organization Name:ANDREA K GALE DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-877-7237
Mailing Address - Street 1:421 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5040
Mailing Address - Country:US
Mailing Address - Phone:815-633-7272
Mailing Address - Fax:815-633-7274
Practice Address - Street 1:2826 WOODHILL DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6340
Practice Address - Country:US
Practice Address - Phone:815-877-7237
Practice Address - Fax:815-633-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008655261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service