Provider Demographics
NPI:1407392624
Name:GARDNER, SPENCER CHASE (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:CHASE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 S REDWOOD RD STE C3
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4275
Mailing Address - Country:US
Mailing Address - Phone:801-987-0335
Mailing Address - Fax:
Practice Address - Street 1:5204 S REDWOOD RD STE C3
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-4275
Practice Address - Country:US
Practice Address - Phone:801-580-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7733054-48102255A2300X
UT7733054-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000097463Medicare PIN