Healthcare Provider Details

I. General information

NPI: 1265572671
Provider Name (Legal Business Name): DR TIMOTHY W GALLAGHER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 WILLIAMS ST
LEOMINSTER MA
01453-3276
US

IV. Provider business mailing address

54 WILLIAMS ST
LEOMINSTER MA
01453-3276
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-0555
  • Fax: 978-537-2193
Mailing address:
  • Phone: 978-537-0555
  • Fax: 978-537-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2172
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY GALLAGHER
Title or Position: OWNER
Credential: DC
Phone: 978-537-0555