Provider Demographics
NPI:1134455918
Name:GARDNER, NEIL A (DC)
Entity type:Individual
Prefix:DR
First Name:NEIL
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 1:2205 TARPLEY RD
Mailing Address - Street 2:APT 1004
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2665
Mailing Address - Country:US
Mailing Address - Phone:214-432-5464
Mailing Address - Fax:623-433-3998
Practice Address - Street 1:107 S MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3338
Practice Address - Country:US
Practice Address - Phone:214-432-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11301111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology