Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 0104556919 | VA |
NPI | 1215217740 |
---|---|
Provider Name | Kevin Patrick Ward |
First Address | Falls Church, VA 22046-4121 |
Second Address | Fairfax, VA 22032-2236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2011 |
Last Update Date | 18/02/2015 |