Gallick Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5073 Issued in WI

Legal business name

GALLICK CHIROPRACTIC LLC

Doing business as

Core Spine

Practice address

4753 County Highway J
Lake Hallie, WI 54729-3387

Phone

(720) 448-5274

NPI assigned

May 31, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shane Gallick, DCNPI 1932637204

Title

Owner/Clinic Director

Phone

(720) 448-5274

Specialties & licenses 1

Addresses

Other names 1

• Core Spine Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shane Gallick, DC

  • Chiropractor
  • Lake Hallie, WI
  • NPI 1932637204
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1285162594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4753 COUNTY HIGHWAY J",
            "city": "LAKE HALLIE",
            "state": "WI",
            "postal_code": "547293387",
            "telephone_number": "720-448-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4753 COUNTY HIGHWAY J",
            "city": "LAKE HALLIE",
            "state": "WI",
            "postal_code": "547293387",
            "telephone_number": "720-448-5274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLICK CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GALLICK",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "720-448-5274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Core Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Frank A Boutiette, PT, DPT
• Elizabeth Grace Farvour, PT, DPT
• Shane Gallick, DC
• Michael J Gilboy, PT
• Aaron A Gustum, DPT
• Northwoods Sport & Hand, Inc (Northwoods Therapy Associates)
• Dakota Timothy Rau, PHARMD

• Chiropractor in Lake Hallie, WI
• Providers in Lake Hallie, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.