Provider Demographics
NPI:1013426998
Name:GARDNER, NICHOLAS ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALEXANDER
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 1:1101 NEW WORLD CIR APT 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8525
Mailing Address - Country:US
Mailing Address - Phone:973-903-7765
Mailing Address - Fax:
Practice Address - Street 1:290 DANIEL WEBSTER HWY UNIT 2A
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5806
Practice Address - Country:US
Practice Address - Phone:603-630-3594
Practice Address - Fax:603-250-2938
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5528111N00000X
NH1023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor