Active NPI
Gary Russell Hardeman, DC
- Chiropractor
- Wildomar, CA
National Provider Identifier
1790723518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC21349
- Practice address
- 32246 Clinton Keith Rd
Suite 102
Wildomar, CA 92595-7320 - Phone
- (951) 677-8997
- Fax
- (951) 678-2893
- NPI assigned
- Jun 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC21349 | CA | Primary |
Addresses
Primary practice location
32246 Clinton Keith Rd
Suite 102
Wildomar, CA 92595-7320
Mailing address
32246 Clinton Keith Rd
Suite 102
Wildomar, CA 92595-7320
Phone (951) 678-9063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC21349 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515024000000",
"number": "1790723518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32246 CLINTON KEITH RD",
"address_2": "SUITE 102",
"city": "WILDOMAR",
"state": "CA",
"postal_code": "925957320",
"telephone_number": "951-678-9063",
"fax_number": "951-678-2893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32246 CLINTON KEITH RD",
"address_2": "SUITE 102",
"city": "WILDOMAR",
"state": "CA",
"postal_code": "925957320",
"telephone_number": "951-677-8997",
"fax_number": "951-678-2893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDEMAN",
"first_name": "GARY",
"middle_name": "RUSSELL",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-03",
"last_updated": "2018-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC21349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wildomar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.