Provider Demographics
NPI:1720268501
Name:GARDNER CHIROPRACTIC HEALTH AND REHABILITATION LLC
Entity Type:Organization
Organization Name:GARDNER CHIROPRACTIC HEALTH AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-9900
Mailing Address - Street 1:805 HILLSDOWNE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 HILLSDOWNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7308
Practice Address - Country:US
Practice Address - Phone:614-794-9900
Practice Address - Fax:614-794-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2331784Medicaid
9354691Medicare PIN