Provider Demographics
NPI:1215095690
Name:GALBREATH, JOHN W (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GALBREATH
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 1:4803 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1116
Mailing Address - Country:US
Mailing Address - Phone:618-465-2419
Mailing Address - Fax:618-463-0759
Practice Address - Street 1:1417 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3964
Practice Address - Country:US
Practice Address - Phone:618-465-2419
Practice Address - Fax:618-463-0759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204741Medicare ID - Type UnspecifiedMEDICARE ID
ILT37259Medicare UPIN