Provider Demographics
NPI:1497455992
Name:GARDNER, BRETT ALLEN (DC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:ALLEN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 CURWENSVILLE TYRONE HWY
Mailing Address - Street 2:
Mailing Address - City:CURWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16833-6748
Mailing Address - Country:US
Mailing Address - Phone:814-553-0641
Mailing Address - Fax:
Practice Address - Street 1:12060 CURWENSVILLE TYRONE HWY
Practice Address - Street 2:
Practice Address - City:CURWENSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16833-6748
Practice Address - Country:US
Practice Address - Phone:814-553-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC01809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor