Provider Demographics
NPI:1851510705
Name:GARDNER HEALTH & WELLNESS CE
Entity Type:Organization
Organization Name:GARDNER HEALTH & WELLNESS CE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-663-6045
Mailing Address - Street 1:4120 E 51ST ST
Mailing Address - Street 2:STE D
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3639
Mailing Address - Country:US
Mailing Address - Phone:918-663-6045
Mailing Address - Fax:
Practice Address - Street 1:4120 E 51ST ST
Practice Address - Street 2:STE D
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3639
Practice Address - Country:US
Practice Address - Phone:918-663-6045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522111Medicare PIN