Provider Demographics
NPI:1831233782
Name:GALLARDO, THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:GALLARDO
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 1:135 N JACKSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1917
Mailing Address - Country:US
Mailing Address - Phone:408-258-3200
Mailing Address - Fax:
Practice Address - Street 1:135 N JACKSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1917
Practice Address - Country:US
Practice Address - Phone:408-258-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00DC25056Medicare ID - Type Unspecified