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General NPI Number Information
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NPI Number | 1134510704
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Entity Type | Organization
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Legal Business Name | WARD CHIROPRACTIC AND REHABILITATION
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 10515 BRADDOCK RD STE B
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City | FAIRFAX
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State | VA
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Zip | 22032-2236
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Country | US
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Telephone | 814-571-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 10515 BRADDOCK RD STE B
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City | FAIRFAX
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State | VA
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Zip | 22032-2236
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Country | US
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Telephone | 814-571-0027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN WARD
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Credential |
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Telephone | 814-571-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 0104556919
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License Number State | VA
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