Provider Demographics
NPI:1407036684
Name:WARD, GREGORY HERBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HERBERT
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 1:933 VALE TERRACE DR STE C
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5213
Mailing Address - Country:US
Mailing Address - Phone:760-758-3214
Mailing Address - Fax:760-945-0643
Practice Address - Street 1:933 VALE TERRACE DR STE C
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5213
Practice Address - Country:US
Practice Address - Phone:760-758-3214
Practice Address - Fax:760-945-0643
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor