Provider Demographics
NPI:1386713261
Name:WARD, STEPHEN GEOFFREY JR (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GEOFFREY
Last Name:WARD
Suffix:JR
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 1:8220 COMMONWEALTH DRIVE
Mailing Address - Street 2:105
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-942-0980
Mailing Address - Fax:
Practice Address - Street 1:8220 COMMONWEALTH DR
Practice Address - Street 2:105
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5371
Practice Address - Country:US
Practice Address - Phone:952-942-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 3524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002137Medicare ID - Type Unspecified