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General NPI Number Information
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NPI Number | 1184725384
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Entity Type | Individual
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Provider Name | RICHARD ST. JOHN GARDNER DC
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 N MATHILDA AVE
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City | SUNNYVALE
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State | CA
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Zip | 94085-4222
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Country | US
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Telephone | 408-739-0987
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Fax | 408-739-0993
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Provider Business Mailing Address
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Address Line | 415 N. MATHILDA AVE.
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City | SUNNYVALE
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State | CA
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Zip | 94086
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Country | US
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Telephone | 408-739-0987
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Fax | 408-739-0993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CA19796
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License Number State | CA
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