Provider Demographics
NPI:1972876845
Name:WARD, JEREMY ROSS (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROSS
Last Name:WARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4211 LAKE STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-990-5497
Mailing Address - Fax:337-990-5570
Practice Address - Street 1:4211 LAKE STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-990-5497
Practice Address - Fax:337-990-5570
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11914111N00000X
LA1645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor