Provider Demographics
NPI:1700911005
Name:WARDE, KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:WARDE
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:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-200-7692
Mailing Address - Fax:858-200-7692
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26165111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70007OtherBLUE CROSS BLUE SHIELD
FL70007Medicare ID - Type Unspecified