Provider Demographics
NPI:1114517380
Name:FORWARD SPINE CENTER LLC
Entity Type:Organization
Organization Name:FORWARD SPINE CENTER LLC
Other - Org Name:FORWARD SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLESK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-599-6920
Mailing Address - Street 1:701 DECATUR AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4363
Mailing Address - Country:US
Mailing Address - Phone:763-332-2680
Mailing Address - Fax:
Practice Address - Street 1:701 DECATUR AVE N STE 102
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4363
Practice Address - Country:US
Practice Address - Phone:763-332-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty