Provider Demographics
NPI:1831509397
Name:GALT CHIROPRACTIC
Entity type:Organization
Organization Name:GALT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-652-2631
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-0338
Mailing Address - Country:US
Mailing Address - Phone:701-652-2631
Mailing Address - Fax:701-652-2631
Practice Address - Street 1:615 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-1661
Practice Address - Country:US
Practice Address - Phone:701-652-2631
Practice Address - Fax:701-652-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4340OtherBC/BS OF ND
ND15656Medicaid
NDN4340OtherMEDICARE
ND15656Medicaid