Provider Demographics
NPI:1083731624
Name:WARD CLINIC PA
Entity Type:Organization
Organization Name:WARD CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARD
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, MD, NMD
Authorized Official - Phone:208-221-2225
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:208-232-9485
Practice Address - Street 1:2186 COLONIAL LN
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2512
Practice Address - Country:US
Practice Address - Phone:208-221-2225
Practice Address - Fax:208-232-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC508111NX0100X
IDI175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Not Answered175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty