Provider Demographics
NPI:1376532143
Name:FOREST, STEVEN J (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:FOREST
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 1:2232 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4417
Mailing Address - Country:US
Mailing Address - Phone:510-522-1818
Mailing Address - Fax:510-522-1108
Practice Address - Street 1:2232 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4417
Practice Address - Country:US
Practice Address - Phone:510-522-1818
Practice Address - Fax:510-522-1108
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0133081Medicare ID - Type Unspecified
CAT04966Medicare UPIN