Healthcare Provider Details

I. General information

NPI: 1700911005
Provider Name (Legal Business Name): KEITH WARDE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 2ND ST
ENCINITAS CA
92024-3505
US

IV. Provider business mailing address

PO BOX 1833
SOLANA BEACH CA
92075
US

V. Phone/Fax

Practice location:
  • Phone: 858-200-7692
  • Fax: 858-200-7692
Mailing address:
  • Phone: 858-200-7692
  • Fax: 858-200-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number26165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: