Provider Demographics
NPI:1043421969
Name:BARDIN, GARETT BLAINE (DC)
Entity Type:Individual
Prefix:
First Name:GARETT
Middle Name:BLAINE
Last Name:BARDIN
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 1:7222 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5567
Mailing Address - Country:US
Mailing Address - Phone:941-921-4884
Mailing Address - Fax:941-921-4884
Practice Address - Street 1:7222 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5567
Practice Address - Country:US
Practice Address - Phone:941-921-4884
Practice Address - Fax:941-921-4883
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8557111N00000X
FL12433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3541Medicare PIN
TX00703UMedicare UPIN
TXU86219Medicare UPIN