Provider Demographics
NPI:1316050149
Name:GALLEBERG, DAVID ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:GALLEBERG
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 1:5350 E VIKING BLVD
Mailing Address - Street 2:PO BOX 645
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8014
Mailing Address - Country:US
Mailing Address - Phone:651-462-5599
Mailing Address - Fax:651-462-5583
Practice Address - Street 1:5350 E VIKING BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8014
Practice Address - Country:US
Practice Address - Phone:651-462-5599
Practice Address - Fax:651-462-5583
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor