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General NPI Number Information
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NPI Number | 1780050484
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Entity Type | Individual
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Provider Name | MARY WARD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 5801 N. ATLANTIC AVE. #104
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-3926
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Country | US
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Telephone | 321-453-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 N ATLANTIC AVE # 104
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-3926
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Country | US
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Telephone | 321-453-7005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 59-2784887
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License Number State | FL
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