MEDICARE: DR. ADAM GLENN GARDNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1590	NM

General Provider Information

NPI Number	:	1578554069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM GLENN GARDNER DC

Provider Business Mailing Address
First Line	:	1925 HAMLET CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3507
Country	:	US
Telephone Number	:	505-323-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MONTGOMERY BLVD NE
Second Line	:	SUITE 114
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2501
Country	:	US
Telephone Number	:	505-296-8040
Fax Number	:	505-296-3304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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