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General NPI Number Information
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NPI Number | 1497961031
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Entity Type | Organization
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Legal Business Name | EASY SPINE
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 4405 E WEST HWY SUITE 504-A
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City | BETHESDA
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State | MD
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Zip | 20814-4522
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Country | US
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Telephone | 301-986-4810
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Fax | 301-986-4872
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Provider Business Mailing Address
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Address Line | 4405 E WEST HWY SUITE 504-A
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City | BETHESDA
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State | MD
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Zip | 20814-4522
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Country | US
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Telephone | 301-986-4810
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Fax | 301-986-4872
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STEVEN GARDNER
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Credential | D.C.
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Telephone | 301-986-4810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01840
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License Number State | MD
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