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General NPI Number Information
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NPI Number | 1861891772
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Entity Type | Organization
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Legal Business Name | GARDNER CHIROPRACTIC: FAMILY AND WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 3000 JOE DIMAGGIO BLVD STE 54
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City | ROUND ROCK
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State | TX
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Zip | 78665-3922
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Country | US
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Telephone | 512-387-3308
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Fax | 512-387-3309
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Provider Business Mailing Address
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Address Line | 3000 JOE DIMAGGIO BLVD STE 54
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City | ROUND ROCK
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State | TX
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Zip | 78665-3922
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Country | US
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Telephone | 512-387-3308
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Fax | 512-387-3309
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JENNIFER ANNE GARDNER MCMORRIS
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Credential | D.C.
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Telephone | 512-387-3308
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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 | 12649
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License Number State | TX
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