Provider Demographics
NPI:1326251034
Name:FORSBERG, KARL VICTOR (DC, CKTP, QME)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:VICTOR
Last Name:FORSBERG
Suffix:
Gender:M
Credentials:DC, CKTP, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TERMINAL WAY STE 219
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3258
Mailing Address - Country:US
Mailing Address - Phone:775-393-9894
Mailing Address - Fax:
Practice Address - Street 1:1201 TERMINAL WAY STE 219
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3258
Practice Address - Country:US
Practice Address - Phone:775-393-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30090111N00000X
NVB-01027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor