Provider Demographics
NPI:1780937698
Name:GALLUP, SHANA ALINA (DC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:ALINA
Last Name:GALLUP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:ALINA
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:990 HGHLAND DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0000
Mailing Address - Country:US
Mailing Address - Phone:858-509-2629
Mailing Address - Fax:858-481-8816
Practice Address - Street 1:990 HIGHLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2408
Practice Address - Country:US
Practice Address - Phone:858-509-2629
Practice Address - Fax:858-481-8816
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor