Provider Demographics
NPI:1053487280
Name:FORR, KIRK (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:FORR
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 1:4499 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1417
Mailing Address - Country:US
Mailing Address - Phone:810-743-8033
Mailing Address - Fax:810-743-8033
Practice Address - Street 1:4499 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1417
Practice Address - Country:US
Practice Address - Phone:810-743-8033
Practice Address - Fax:810-743-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B55048Medicare ID - Type Unspecified