Provider Demographics
NPI:1215217740
Name:WARD, KEVIN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:WARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:437 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4121
Mailing Address - Country:US
Mailing Address - Phone:814-571-0027
Mailing Address - Fax:703-293-2954
Practice Address - Street 1:10515 BRADDOCK RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2236
Practice Address - Country:US
Practice Address - Phone:703-672-1661
Practice Address - Fax:703-293-2954
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556919111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation