Provider Demographics
NPI:1972970648
Name:GARDNER, ROSS A (DC)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:A
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 1:333 17TH ST
Mailing Address - Street 2:STE N
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5686
Mailing Address - Country:US
Mailing Address - Phone:772-563-2900
Mailing Address - Fax:772-563-2961
Practice Address - Street 1:333 17TH ST
Practice Address - Street 2:STE N
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5686
Practice Address - Country:US
Practice Address - Phone:772-563-2900
Practice Address - Fax:772-563-2961
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012691111N00000X
FL11787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor