Provider Demographics
NPI:1265467955
Name:WARD, KEITH EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EDWIN
Last Name:WARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MELODY LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5181
Mailing Address - Country:US
Mailing Address - Phone:916-781-3444
Mailing Address - Fax:916-781-3926
Practice Address - Street 1:1220 MELODY LN
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5181
Practice Address - Country:US
Practice Address - Phone:916-781-3444
Practice Address - Fax:916-781-3926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0137060Medicare ID - Type Unspecified