Provider Demographics
NPI:1366788853
Name:GALLANT, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GALLANT
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 1:1059 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5756
Mailing Address - Country:US
Mailing Address - Phone:727-733-6501
Mailing Address - Fax:
Practice Address - Street 1:1059 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5756
Practice Address - Country:US
Practice Address - Phone:727-733-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10796111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology