Healthcare Provider Details

I. General information

NPI: 1396859070
Provider Name (Legal Business Name): ROBERT LEE GALLOWAY III R.PH, D.C., C.C.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 FM 1960 RD W
HOUSTON TX
77070-6211
US

IV. Provider business mailing address

9410 FM 1960 RD W
HOUSTON TX
77070-6211
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-4828
  • Fax: 281-890-7721
Mailing address:
  • Phone: 281-890-4828
  • Fax: 281-890-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: