Provider Demographics
NPI:1356303424
Name:FORSYTHE, TAMARA (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:FORSYTHE
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 1:16 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3420
Mailing Address - Country:US
Mailing Address - Phone:720-652-6565
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3420
Practice Address - Country:US
Practice Address - Phone:720-652-6565
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC48533Medicare ID - Type UnspecifiedCHIROPRACTIC