Healthcare Provider Details

I. General information

NPI: 1932295524
Provider Name (Legal Business Name): RICHARD D GALLAGHER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N BROADWAY AVE
RED LODGE MT
59068-9287
US

IV. Provider business mailing address

PO BOX 1932
RED LODGE MT
59068-1932
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-4433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI-CHI-LIC-3469
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: