Provider Demographics
NPI:1457613713
Name:GARDNER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GARDNER CHIROPRACTIC LLC
Other - Org Name:WORKMAN CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPERTY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-524-4371
Mailing Address - Street 1:102 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:KS
Mailing Address - Zip Code:67455-2004
Mailing Address - Country:US
Mailing Address - Phone:785-524-4371
Mailing Address - Fax:785-524-4375
Practice Address - Street 1:102 E ELM ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:KS
Practice Address - Zip Code:67455-2004
Practice Address - Country:US
Practice Address - Phone:785-524-4371
Practice Address - Fax:785-524-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty