Provider Demographics
NPI:1952472136
Name:WARD, KERRI E (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRI
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 1:304 NW BETHANY DR.
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3578
Mailing Address - Country:US
Mailing Address - Phone:772-344-1431
Mailing Address - Fax:772-344-1435
Practice Address - Street 1:304 NW BETHANY DR.
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3578
Practice Address - Country:US
Practice Address - Phone:772-344-1431
Practice Address - Fax:772-344-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7838OtherMEDICARE GROUP
FL381511100Medicaid
FL202306175OtherTAX ID
FL1992993471OtherMEDICARE GROUP NPI
FLK7838OtherMEDICARE GROUP
FL70165AMedicare ID - Type Unspecified