Provider Demographics
NPI:1104189570
Name:FORSTIE, SEPIDEH (DC)
Entity Type:Individual
Prefix:DR
First Name:SEPIDEH
Middle Name:
Last Name:FORSTIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SEPI
Other - Middle Name:
Other - Last Name:FORSTIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:605 CALLE JUAREZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3021
Mailing Address - Country:US
Mailing Address - Phone:949-939-2928
Mailing Address - Fax:949-218-5081
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6315
Practice Address - Country:US
Practice Address - Phone:949-939-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23806111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician