MEDICARE: GOLDEN CHIROPRACTIC SPA, LLC

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	905275	AK

General Provider Information

NPI Number	:	1265628069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN CHIROPRACTIC SPA, LLC

Provider Business Mailing Address
First Line	:	1995 E COALTON RD
Second Line	:	#65-101
City	:	SUPERIOR
State	:	CO
Zip	:	80027-4419
Country	:	US
Telephone Number	:	303-748-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	303-748-3833
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	DR. ANDREA DIANE GALLAGHER
Credential	:	D.C.
Telephone Number	:	303-748-3833

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	12/20/2008

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