Provider Demographics
NPI:1427122217
Name:GALLO, GLENN G (DC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:G
Last Name:GALLO
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 1:7018 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2508
Mailing Address - Country:US
Mailing Address - Phone:941-792-4357
Mailing Address - Fax:941-792-4341
Practice Address - Street 1:7018 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2508
Practice Address - Country:US
Practice Address - Phone:941-792-4357
Practice Address - Fax:941-792-4341
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0045601111N00000X
SC3198111N00000X
FLCH9399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
52827Medicare UPIN
NYX24881Medicare ID - Type Unspecified