Provider Demographics
NPI:1184725384
Name:GARDNER, RICHARD ST JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ST JOHN
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 1:415 N. MATHILDA AVE.
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086
Mailing Address - Country:US
Mailing Address - Phone:408-739-0987
Mailing Address - Fax:408-739-0993
Practice Address - Street 1:415 N MATHILDA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4222
Practice Address - Country:US
Practice Address - Phone:408-739-0987
Practice Address - Fax:408-739-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA19796111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician