Provider Demographics
NPI:1558690487
Name:GARDNER, PAUL PEDER (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:PEDER
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 1:5425 SOUTH SEMORAN BOULEVARD
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1777
Mailing Address - Country:US
Mailing Address - Phone:407-482-0052
Mailing Address - Fax:407-482-0198
Practice Address - Street 1:5425 SOUTH SEMORAN BOULEVARD
Practice Address - Street 2:SUITE 6A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1777
Practice Address - Country:US
Practice Address - Phone:407-482-0052
Practice Address - Fax:407-482-0198
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor