Provider Demographics
NPI:1750500401
Name:GAINES, J. ARDENIA (NCTMB, LMT)
Entity Type:Individual
Prefix:
First Name:J. ARDENIA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 WARRENTON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1028
Mailing Address - Country:US
Mailing Address - Phone:540-899-1773
Mailing Address - Fax:
Practice Address - Street 1:676 WARRENTON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1028
Practice Address - Country:US
Practice Address - Phone:540-899-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006578111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health