MEDICARE: GERALD J GALVIN CONVERSE CHIROPRACTIC

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	:	1538629001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD J GALVIN CONVERSE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	8014 KITTY HAWK
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	210-658-6000
Fax Number	:	210-658-6843

Provider Business Practice Location Address
First Line	:	8014 KITTY HAWK
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	210-658-6000
Fax Number	:	210-658-6843

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	GERALD J GALVIN
Credential	:	DC
Telephone Number	:	210-658-6000

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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