Provider Demographics
NPI:1245756303
Name:FORSGREN, EMILY HOPE (DC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HOPE
Last Name:FORSGREN
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 1:14805 DETROIT AVE STE 545
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3921
Mailing Address - Country:US
Mailing Address - Phone:216-970-1273
Mailing Address - Fax:
Practice Address - Street 1:14805 DETROIT AVE STE 545
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3921
Practice Address - Country:US
Practice Address - Phone:216-970-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor