Provider Demographics
NPI:1003895350
Name:FORREST CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:FORREST CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BOYSEN
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-8026
Mailing Address - Street 1:80 23RD AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2401
Mailing Address - Country:US
Mailing Address - Phone:563-242-8026
Mailing Address - Fax:
Practice Address - Street 1:80 23RD AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2401
Practice Address - Country:US
Practice Address - Phone:563-242-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherFEDERAL TAX ID #