Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B00495 | NV |
NPI | 1003188210 |
---|---|
Provider Name | Dr. Todd L Gardner |
First Address | Henderson, NV 89052-2982 |
Second Address | Henderson, NV 89052-2982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 01/11/2012 |