Provider Demographics
NPI:1215112412
Name:GALE F COONEY DC PA
Entity type:Organization
Organization Name:GALE F COONEY DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:850-785-9180
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0007
Mailing Address - Country:US
Mailing Address - Phone:850-785-9180
Mailing Address - Fax:850-785-9322
Practice Address - Street 1:2410 LISENBY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3537
Practice Address - Country:US
Practice Address - Phone:850-785-9180
Practice Address - Fax:850-785-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381034800Medicaid
FLP00098307OtherRAILROAD MEDICARE
FLU55011Medicare UPIN
FLP00098307OtherRAILROAD MEDICARE