Provider Demographics
NPI:1881976033
Name:GALLAGHER, SHAUN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:MICHAEL
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 WASHINGTON AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1143
Mailing Address - Country:US
Mailing Address - Phone:570-995-1321
Mailing Address - Fax:
Practice Address - Street 1:1929 W TILGHMAN ST
Practice Address - Street 2:REAR A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4389
Practice Address - Country:US
Practice Address - Phone:570-995-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor