Healthcare Provider Details

I. General information

NPI: 1447356225
Provider Name (Legal Business Name): JEFFREY R. GALT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN ST
CARRINGTON ND
58421-1661
US

IV. Provider business mailing address

615 MAIN ST P.O. BOX 338
CARRINGTON ND
58421-1661
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2631
  • Fax:
Mailing address:
  • Phone: 701-652-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number456
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: