Provider Demographics
NPI:1851820211
Name:GARDNER, ADAM LEE SR (ND, EAMP, LAC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LEE
Last Name:GARDNER
Suffix:SR
Gender:M
Credentials:ND, EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N 163RD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5616
Mailing Address - Country:US
Mailing Address - Phone:206-604-1534
Mailing Address - Fax:
Practice Address - Street 1:925 N 163RD STREET
Practice Address - Street 2:UNIT B
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-604-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60756013171100000X
WANT60755534175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist