Provider Demographics
NPI:1699842922
Name:WARD, JOHN CLITNON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLITNON
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 1:1086 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2746
Mailing Address - Country:US
Mailing Address - Phone:716-893-9200
Mailing Address - Fax:716-893-4646
Practice Address - Street 1:1086 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2746
Practice Address - Country:US
Practice Address - Phone:716-893-9200
Practice Address - Fax:716-893-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010169W111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor