Provider Demographics
NPI:1629052634
Name:WARD, LOIS E (DC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:E
Last Name:WARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3611
Mailing Address - Country:US
Mailing Address - Phone:573-756-2276
Mailing Address - Fax:
Practice Address - Street 1:530 N MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1570
Practice Address - Country:US
Practice Address - Phone:573-756-6496
Practice Address - Fax:573-756-6498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
13922OtherBCBS
13922OtherBCBS