Healthcare Provider Details

I. General information

NPI: 1831509397
Provider Name (Legal Business Name): GALT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN ST
CARRINGTON ND
58421-1661
US

IV. Provider business mailing address

PO BOX 338
CARRINGTON ND
58421-0338
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY R. GALT
Title or Position: OWNER
Credential: DC
Phone: 701-652-2631