Provider Demographics
NPI:1497950703
Name:GARDNER CHIROPRACTIC OFFICE, INC.
Entity Type:Organization
Organization Name:GARDNER CHIROPRACTIC OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-448-0671
Mailing Address - Street 1:14 W MARKET ST
Mailing Address - Street 2:P.O. BOX 30
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2720
Mailing Address - Country:US
Mailing Address - Phone:419-448-0671
Mailing Address - Fax:419-448-0675
Practice Address - Street 1:14 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2720
Practice Address - Country:US
Practice Address - Phone:419-448-0671
Practice Address - Fax:419-448-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199548Medicaid
OH9295761Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OHT46513Medicare UPIN