Provider Demographics
NPI:1710616255
Name:GALJOUR, VAN III (DC)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:
Last Name:GALJOUR
Suffix:III
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 1:1326 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1251
Mailing Address - Country:US
Mailing Address - Phone:985-291-3207
Mailing Address - Fax:
Practice Address - Street 1:187 GREENBRIER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7298
Practice Address - Country:US
Practice Address - Phone:985-291-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor