Healthcare Provider Details

I. General information

NPI: 1487633608
Provider Name (Legal Business Name): NICHOLAS J GALLOWAY II DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MAIN ST
CANTON TX
75103-1439
US

IV. Provider business mailing address

510 W DAVIS ST
DALLAS TX
75208-4705
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-9431
  • Fax: 214-943-9407
Mailing address:
  • Phone: 214-943-9431
  • Fax: 214-943-9407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8610
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: