Provider Demographics
NPI:1083127229
Name:FORLOW, EMMA (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:FORLOW
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3323
Mailing Address - Country:US
Mailing Address - Phone:847-845-2452
Mailing Address - Fax:
Practice Address - Street 1:102 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-8926
Practice Address - Country:US
Practice Address - Phone:815-562-5333
Practice Address - Fax:815-562-5833
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098355111N00000X
IA0984622255A2300X
IL0960050992255A2300X
IL038013495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer