Basic Information
| Provider Information | |||||||||
| NPI: | 1871697367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GALLOWAY CHIROPRACTIC CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14149 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708984149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259249827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 N MCCLESKEY ST | ||||||||
| Address2: | |||||||||
| City: | BOAZ | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359571941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565936363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 04/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | GALLOWAY | ||||||||
| AuthorizedOfficialFirstName: | J ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2565936363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 1771 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 051113379 | 01 | AL | BC AL | OTHER |