Provider Demographics
NPI:1184856973
Name:FORWARD LIVING LTD
Entity Type:Organization
Organization Name:FORWARD LIVING LTD
Other - Org Name:FORWARD LIVING FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRENDAN
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-664-0102
Mailing Address - Street 1:220 N ELDORADO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7703
Mailing Address - Country:US
Mailing Address - Phone:309-664-0102
Mailing Address - Fax:309-664-0112
Practice Address - Street 1:220 N ELDORADO RD
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7703
Practice Address - Country:US
Practice Address - Phone:309-664-0102
Practice Address - Fax:309-664-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty