Provider Demographics
NPI:1861891772
Name:GARDNER CHIROPRACTIC: FAMILY AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:GARDNER CHIROPRACTIC: FAMILY AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GARDNER MCMORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-387-3308
Mailing Address - Street 1:3000 JOE DIMAGGIO BLVD
Mailing Address - Street 2:STE 54
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3922
Mailing Address - Country:US
Mailing Address - Phone:512-387-3308
Mailing Address - Fax:512-387-3309
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD
Practice Address - Street 2:STE 54
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3922
Practice Address - Country:US
Practice Address - Phone:512-387-3308
Practice Address - Fax:512-387-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty