Healthcare Provider Details

I. General information

NPI: 1245311208
Provider Name (Legal Business Name): WARD CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 LAFAYETTE AVE
MATTOON IL
61938-3926
US

IV. Provider business mailing address

1616 LAFAYETTE AVE
MATTOON IL
61938-3926
US

V. Phone/Fax

Practice location:
  • Phone: 217-234-2243
  • Fax: 217-234-2253
Mailing address:
  • Phone: 217-234-2243
  • Fax: 217-234-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TERRY ALLEN WARD
Title or Position: PRESIDENT TREASURER
Credential: DC
Phone: 217-234-2243