Provider Demographics
NPI:1417026774
Name:FORREST, THOMAS RALEIGH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RALEIGH
Last Name:FORREST
Suffix:JR
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 1:102 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2925
Mailing Address - Country:US
Mailing Address - Phone:910-738-7710
Mailing Address - Fax:910-738-7749
Practice Address - Street 1:102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2925
Practice Address - Country:US
Practice Address - Phone:910-738-7710
Practice Address - Fax:910-738-7749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2827111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC618544OtherACN
NC890843UMedicaid
NC0843UOtherBCBS
NCB1429OtherMEDCOST
NC245027AMedicare ID - Type Unspecified
NCB1429OtherMEDCOST