=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154475978
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL CHRISTINA GARDNER DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 HILLSDOWNE ROAD
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-794-9900
-----------------------------------------------------
Fax | 614-794-9977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 HILLSDOWNE ROAD
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-794-9900
-----------------------------------------------------
Fax | 614-794-9977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3011
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------