Provider Demographics
NPI:1750339164
Name:GARDNER, GREY CHARLES (DC)
Entity type:Individual
Prefix:MR
First Name:GREY
Middle Name:CHARLES
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 1:1644 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-656-7000
Mailing Address - Fax:406-656-8729
Practice Address - Street 1:1644 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-656-7000
Practice Address - Fax:406-656-8729
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT004015053OtherWORK COMP
MT000041261OtherBCBS
MT000080381Medicare ID - Type Unspecified
U27814Medicare UPIN