Provider Demographics
NPI:1780089789
Name:GARDNER CHIROPRACTIC, PA
Entity type:Organization
Organization Name:GARDNER CHIROPRACTIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-787-5925
Mailing Address - Street 1:3316 WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1656
Mailing Address - Country:US
Mailing Address - Phone:903-787-5925
Mailing Address - Fax:903-787-5926
Practice Address - Street 1:3316 WOODS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1656
Practice Address - Country:US
Practice Address - Phone:903-787-5925
Practice Address - Fax:903-787-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty