Provider Demographics
NPI:1811179625
Name:GALLAGHER FAMILY CHIROPRACTIC, LTD
Entity type:Organization
Organization Name:GALLAGHER FAMILY CHIROPRACTIC, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-571-1480
Mailing Address - Street 1:9511 DELEGATES ROW
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3807
Mailing Address - Country:US
Mailing Address - Phone:317-571-1480
Mailing Address - Fax:317-571-1481
Practice Address - Street 1:9511 DELEGATES ROW
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3807
Practice Address - Country:US
Practice Address - Phone:317-571-1480
Practice Address - Fax:317-571-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001422A111N00000X
IN08000929A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200358110AMedicaid