Provider Demographics
NPI:1053395632
Name:GALLIGAN, KATHLEEN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:GALLIGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3459
Mailing Address - Country:US
Mailing Address - Phone:503-635-1236
Mailing Address - Fax:503-697-4741
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:STE 201
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3459
Practice Address - Country:US
Practice Address - Phone:503-635-1236
Practice Address - Fax:503-697-4741
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111559Medicaid
109100Medicare ID - Type Unspecified