Provider Demographics
NPI:1497508113
Name:GARDINIER, JORDAN LEIGH (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH
Last Name:GARDINIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 E 61ST ST N
Mailing Address - Street 2:STE 1A
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219
Mailing Address - Country:US
Mailing Address - Phone:316-369-0037
Mailing Address - Fax:
Practice Address - Street 1:425 E 61ST ST N
Practice Address - Street 2:STE 1A
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219
Practice Address - Country:US
Practice Address - Phone:316-369-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor