Provider Demographics
NPI:1336324722
Name:FORTH, WILLIAM DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAVID
Last Name:FORTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1874
Mailing Address - Country:US
Mailing Address - Phone:865-686-1600
Mailing Address - Fax:865-686-3380
Practice Address - Street 1:2905 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1874
Practice Address - Country:US
Practice Address - Phone:865-686-1600
Practice Address - Fax:865-686-3380
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor