Provider Demographics
NPI:1871760090
Name:GARDNER, STEPHEN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
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 1:201 DARTMOUTH DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2219
Mailing Address - Country:US
Mailing Address - Phone:505-265-9656
Mailing Address - Fax:595-265-0296
Practice Address - Street 1:201 DARTMOUTH DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2219
Practice Address - Country:US
Practice Address - Phone:505-265-9656
Practice Address - Fax:505-265-0296
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1275607426OtherTYPE 2 NPI