Healthcare Provider Details

I. General information

NPI: 1053633156
Provider Name (Legal Business Name): GALLOWAY PAIN CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 GALLOWAY RD SUITE 7
MIAMI FL
33176-2413
US

IV. Provider business mailing address

9300 GALLOWAY RD SUITE 7
MIAMI FL
33176-2413
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-3533
  • Fax: 305-595-3551
Mailing address:
  • Phone: 305-595-3533
  • Fax: 305-595-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2167
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2167
License Number StateFL

VIII. Authorized Official

Name: MELODY CHUNG
Title or Position: PRESIDENT
Credential: A.P.
Phone: 305-595-3533