Healthcare Provider Details

I. General information

NPI: 1154408987
Provider Name (Legal Business Name): BAGLEY CHIROPRACTIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CLEARWATER AVE. NW
BAGLEY MN
56621-1003
US

IV. Provider business mailing address

PO BOX B
BAGLEY MN
56621-1003
US

V. Phone/Fax

Practice location:
  • Phone: 218-694-6253
  • Fax: 218-694-6270
Mailing address:
  • Phone: 218-694-6253
  • Fax: 218-694-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4858
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID ANDREW GALLOWAY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 218-694-6253