Healthcare Provider Details

I. General information

NPI: 1043324205
Provider Name (Legal Business Name): KEVIN A. GALL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ROCK AVE
GREEN BROOK NJ
08812-2616
US

IV. Provider business mailing address

20 DEER PATH CIR
GREEN BROOK NJ
08812-2048
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-3900
  • Fax: 732-968-3944
Mailing address:
  • Phone: 908-510-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC03899
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: