Provider Demographics
NPI:1316944036
Name:GALLAGHER, MICHAEL DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:GALLAGHER
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 1:506 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-9554
Mailing Address - Country:US
Mailing Address - Phone:608-795-4820
Mailing Address - Fax:608-794-4879
Practice Address - Street 1:506 CROCKER ST
Practice Address - Street 2:
Practice Address - City:MAZOMANIE
Practice Address - State:WI
Practice Address - Zip Code:53560-9554
Practice Address - Country:US
Practice Address - Phone:608-795-4820
Practice Address - Fax:608-794-4879
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3549-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35181Medicare ID - Type Unspecified
WIU75515Medicare UPIN