Provider Demographics
NPI:1982759502
Name:WARD, MICHAEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
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 1:2 E BLACKWELL ST STE 14
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4645
Mailing Address - Country:US
Mailing Address - Phone:973-361-3500
Mailing Address - Fax:973-361-1360
Practice Address - Street 1:2 E BLACKWELL ST STE 14
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4645
Practice Address - Country:US
Practice Address - Phone:973-361-3500
Practice Address - Fax:973-361-1360
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ619013PM7Medicare ID - Type Unspecified
NJU54489Medicare UPIN