Provider Demographics
NPI:1457416398
Name:WARD, JEFF CHRISTOPHER (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:CHRISTOPHER
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 1:113 ABNER JACKSON PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5156
Mailing Address - Country:US
Mailing Address - Phone:979-480-9922
Mailing Address - Fax:979-480-9923
Practice Address - Street 1:113 ABNER JACKSON PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5156
Practice Address - Country:US
Practice Address - Phone:979-480-9922
Practice Address - Fax:979-480-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612924Medicare PIN