Healthcare Provider Details

I. General information

NPI: 1033287040
Provider Name (Legal Business Name): ROBERT E WARD III DC, NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WARREN AVE
POCATELLO ID
83201-4621
US

IV. Provider business mailing address

PO BOX 3052
POCATELLO ID
83206-3052
US

V. Phone/Fax

Practice location:
  • Phone: 208-241-6510
  • Fax: 208-234-2052
Mailing address:
  • Phone: 208-221-2225
  • Fax: 208-234-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number508
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number508C
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number508C
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number508
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: