Provider Demographics
NPI:1346419108
Name:GARDNER, AARON KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:KEITH
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0606
Mailing Address - Country:US
Mailing Address - Phone:903-653-0499
Mailing Address - Fax:903-234-1911
Practice Address - Street 1:300 E LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7912
Practice Address - Country:US
Practice Address - Phone:903-234-2225
Practice Address - Fax:903-234-1911
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor