Individual
MR. CORY LANE GARDNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
301 ORCHARD ST, ELKINS, WV 26241-3338
(304) 636-2411
(304) 636-2411
Mailing address
301 ORCHARD ST, ELKINS, WV 26241-3338
(304) 636-2411
(304) 636-2411
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
803
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11351236
CIGNA
WV
05
—
3810000836
—
WV
01
—
P00209889
RAILROAD MEDICARE
WV
01
—
WV00803
THE HEALTH PLAN
WV
Enumeration date
06/12/2006
Last updated
07/08/2007
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