Provider Demographics
NPI:1184914731
Name:WARD, CARLA (DC)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
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 1:1820 N BELT E
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5523
Mailing Address - Country:US
Mailing Address - Phone:618-233-4458
Mailing Address - Fax:
Practice Address - Street 1:1820 N BELT E
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5523
Practice Address - Country:US
Practice Address - Phone:618-233-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor