Provider Demographics
NPI:1083851349
Name:JUSTIN M WARD DC PC
Entity Type:Organization
Organization Name:JUSTIN M WARD DC PC
Other - Org Name:WARD FAMILY CHIROPRACTIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-649-3318
Mailing Address - Street 1:211 DELANO AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2250
Mailing Address - Country:US
Mailing Address - Phone:740-779-1015
Mailing Address - Fax:740-779-1015
Practice Address - Street 1:211 DELANO AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2250
Practice Address - Country:US
Practice Address - Phone:740-779-1015
Practice Address - Fax:740-779-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2960390Medicaid
OH2960345Medicaid
OH4256121Medicare PIN
OH9380701Medicare PIN