Provider Demographics
NPI:1477676906
Name:WARD, LARRY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RAY
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 1:5460 S GARNETT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5916
Mailing Address - Country:US
Mailing Address - Phone:918-794-0310
Mailing Address - Fax:918-591-2855
Practice Address - Street 1:5460 S GARNETT RD
Practice Address - Street 2:SUITE H
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5916
Practice Address - Country:US
Practice Address - Phone:918-794-0310
Practice Address - Fax:918-591-2855
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor