Provider Demographics
NPI:1295907632
Name:JOSEPH M. WARDIE, D.C., P.C.
Entity type:Organization
Organization Name:JOSEPH M. WARDIE, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WARDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-881-3494
Mailing Address - Street 1:20567 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1655
Mailing Address - Country:US
Mailing Address - Phone:313-881-3494
Mailing Address - Fax:313-884-3490
Practice Address - Street 1:20567 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1655
Practice Address - Country:US
Practice Address - Phone:313-881-3494
Practice Address - Fax:313-884-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty