Provider Demographics
NPI:1194894584
Name:GALLAGHER, COLLEEN P (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:P
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28571 SHRIKE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1347
Mailing Address - Country:US
Mailing Address - Phone:949-215-2287
Mailing Address - Fax:
Practice Address - Street 1:28571 SHRIKE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1347
Practice Address - Country:US
Practice Address - Phone:949-215-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562561414OtherTAX ID