Provider Demographics
NPI:1255472494
Name:GAZDAR, WILLIAM MICHAEL (DC CCSP,QME)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:GAZDAR
Suffix:
Gender:M
Credentials:DC CCSP,QME
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Mailing Address - Street 1:2021 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE C-204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3391
Mailing Address - Country:US
Mailing Address - Phone:925-939-2225
Mailing Address - Fax:925-939-8017
Practice Address - Street 1:2021 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE C-204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3391
Practice Address - Country:US
Practice Address - Phone:925-939-2225
Practice Address - Fax:925-939-8017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC 20466111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician