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Individual
DR. PERICLES CHRISTO GARDIANOS
Active
Individual
DR. PERICLES CHRISTO GARDIANOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
MC 04656
NJ
111N00000X
Chiropractor
Primary
X-007623-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108 6429
HIPPA EXTENSION CONF. NUM
NY
01
—
C07623-4
NY WORKERS COMPENSATION N
NY
01
—
MC 04656
NJ LICENSE #
NJ
01
—
P 2515 736
OXFORD NON-PAR. PROVIDER
NY
01
—
X-007623-1
NY CHIRO. LICENSE #
NY
01
—
X0-C27
EMPIRE BC/BS
NY
Enumeration date
07/03/2006
Last updated
07/08/2007
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