Provider Demographics
NPI:1144301078
Name:GALLAGHER, MATTHEW J (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 WOODROW WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2144
Mailing Address - Country:US
Mailing Address - Phone:920-884-9308
Mailing Address - Fax:
Practice Address - Street 1:502 GREENE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2820
Practice Address - Country:US
Practice Address - Phone:920-884-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38957500Medicaid
WIV02119Medicare UPIN