Provider Demographics
NPI:1104960467
Name:GALLAGHER FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:GALLAGHER FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-398-1800
Mailing Address - Street 1:143 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1123
Mailing Address - Country:US
Mailing Address - Phone:973-398-1800
Mailing Address - Fax:973-398-3770
Practice Address - Street 1:143 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1123
Practice Address - Country:US
Practice Address - Phone:973-398-1800
Practice Address - Fax:973-398-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019887860001Medicaid
PA1019887860001Medicaid
PA111916Medicare PIN