Healthcare Provider Details

I. General information

NPI: 1336146604
Provider Name (Legal Business Name): RICHARD M. GARDNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 COUNTY ROAD 529
LOUDONVILLE OH
44842-9202
US

IV. Provider business mailing address

324 HOHUM DR.
BRINKHAVEN OH
43006
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-5551
  • Fax: 419-994-5552
Mailing address:
  • Phone: 740-599-6197
  • Fax: 419-994-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: