Provider Demographics
NPI:1083652804
Name:GARDNER, WILLIAM ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:GARDNER
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 1:664 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-1410
Mailing Address - Country:US
Mailing Address - Phone:215-547-1977
Mailing Address - Fax:215-547-1375
Practice Address - Street 1:664 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1410
Practice Address - Country:US
Practice Address - Phone:215-547-1977
Practice Address - Fax:215-547-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ008904111N00000X
PADC009078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor