Provider Demographics
NPI:1033287040
Name:WARD, ROBERT E III (DC, NMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:WARD
Suffix:III
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3052
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-3052
Mailing Address - Country:US
Mailing Address - Phone:208-221-2225
Mailing Address - Fax:208-234-2052
Practice Address - Street 1:135 WARREN AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4621
Practice Address - Country:US
Practice Address - Phone:208-241-6510
Practice Address - Fax:208-234-2052
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID508111NI0013X, 175F00000X
ID508C111NI0900X, 111NX0800X
FM6565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No175F00000XOther Service ProvidersNaturopath