Provider Demographics
NPI:1154628840
Name:DAVID A. FORBES, DC,PC
Entity Type:Organization
Organization Name:DAVID A. FORBES, DC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-364-3398
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:IL
Mailing Address - Zip Code:61537-0116
Mailing Address - Country:US
Mailing Address - Phone:309-364-3398
Mailing Address - Fax:309-364-2059
Practice Address - Street 1:322 EDWARD ST
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537-1502
Practice Address - Country:US
Practice Address - Phone:309-364-3398
Practice Address - Fax:309-364-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35379Medicare UPIN