MEDICARE: THE GALLERY SALON & SPA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1205475399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GALLERY SALON & SPA INC

Provider Business Mailing Address
First Line	:	6312 ARGONNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-3902
Country	:	US
Telephone Number	:	504-482-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	6312 ARGONNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-3902
Country	:	US
Telephone Number	:	504-482-2219
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH A LICHTL
Credential	:
Telephone Number	:	504-482-2219

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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