Provider Demographics
NPI:1316000490
Name:GARDNER, STEVEN ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALLEN
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 1:4405 EAST WEST HIGHWAY
Mailing Address - Street 2:504A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4536
Mailing Address - Country:US
Mailing Address - Phone:301-986-4810
Mailing Address - Fax:301-986-4872
Practice Address - Street 1:4405 EAST WEST HIGHWAY
Practice Address - Street 2:504A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4536
Practice Address - Country:US
Practice Address - Phone:301-986-4810
Practice Address - Fax:301-986-4872
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90515Medicare UPIN
MD491126Medicare PIN