Provider Demographics
NPI:1306208988
Name:GARDINER, COLLEEN (DC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GARDINER
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 1:15404 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 100/L201
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8569
Mailing Address - Country:US
Mailing Address - Phone:509-892-9800
Mailing Address - Fax:509-892-9998
Practice Address - Street 1:15404 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE 100/L201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8569
Practice Address - Country:US
Practice Address - Phone:509-892-9800
Practice Address - Fax:509-892-9998
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60542756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor