Provider Demographics
NPI:1184129553
Name:WARDE SPORTS CHIROPRACTIC AND LASER PC
Entity type:Organization
Organization Name:WARDE SPORTS CHIROPRACTIC AND LASER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-200-7692
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-7833
Mailing Address - Country:US
Mailing Address - Phone:530-568-5060
Mailing Address - Fax:530-925-1190
Practice Address - Street 1:575 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3505
Practice Address - Country:US
Practice Address - Phone:858-200-7692
Practice Address - Fax:858-200-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty