Provider Demographics
NPI:1952405227
Name:GARDINER, LAURA E (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:GARDINER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2726
Mailing Address - Country:US
Mailing Address - Phone:541-548-5089
Mailing Address - Fax:541-504-5353
Practice Address - Street 1:707 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2726
Practice Address - Country:US
Practice Address - Phone:541-548-5089
Practice Address - Fax:541-504-5353
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001295Medicare ID - Type Unspecified
ORR152188Medicare UPIN