Healthcare Provider Details

I. General information

NPI: 1043242407
Provider Name (Legal Business Name): NANCY LEE GALLAGHER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LEE WILLIVER DC

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 LAKESIDE BLVD
LANDING NJ
07850-1123
US

IV. Provider business mailing address

143 LAKESIDE BLVD
LANDING NJ
07850-1123
US

V. Phone/Fax

Practice location:
  • Phone: 973-398-1800
  • Fax: 973-398-3770
Mailing address:
  • Phone: 973-398-1800
  • Fax: 973-398-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00607100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01382000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009584
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: