Healthcare Provider Details

I. General information

NPI: 1346524907
Provider Name (Legal Business Name): MICHAEL GARDINER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12237 PRAIRIE DUNES RD
BOYNTON BEACH FL
33437-6014
US

IV. Provider business mailing address

12237 PRAIRIE DUNES ROAD
BOYNTON BEACH FL
33437
US

V. Phone/Fax

Practice location:
  • Phone: 561-523-0745
  • Fax:
Mailing address:
  • Phone: 561-523-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00206500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: