Provider Demographics
NPI:1417084286
Name:GARDA, CLINTON J (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:J
Last Name:GARDA
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 1:9879 MONTGOMERY ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-891-2111
Mailing Address - Fax:513-891-2113
Practice Address - Street 1:9879 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-891-2111
Practice Address - Fax:513-891-2113
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008673111N00000X
OH4284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK39401OtherMEDICARE ID #
IL5632232OtherBCBS
IL5632232OtherBCBS