Provider Demographics
NPI:1861695207
Name:GALLANT, COLLEEN MARY (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARY
Last Name:GALLANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:188 E 70TH ST
Mailing Address - Street 2:APT #16A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5135
Mailing Address - Country:US
Mailing Address - Phone:212-988-0594
Mailing Address - Fax:212-988-0594
Practice Address - Street 1:300 E 56TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4136
Practice Address - Country:US
Practice Address - Phone:212-935-1700
Practice Address - Fax:212-753-9856
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor