Provider Demographics
NPI:1114154242
Name:FORRESTER, LESLIE ERIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ERIN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3326
Mailing Address - Country:US
Mailing Address - Phone:573-712-2500
Mailing Address - Fax:573-712-2501
Practice Address - Street 1:1251 STERLING DR
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3326
Practice Address - Country:US
Practice Address - Phone:573-712-2500
Practice Address - Fax:573-712-2501
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009012413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor