Provider Demographics
NPI:1437563830
Name:FORUM CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:FORUM CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHEMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-216-2511
Mailing Address - Street 1:3398 FORUM BLVD
Mailing Address - Street 2:#112
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5577
Mailing Address - Country:US
Mailing Address - Phone:812-239-5462
Mailing Address - Fax:
Practice Address - Street 1:3398 FORUM BLVD
Practice Address - Street 2:#112
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5577
Practice Address - Country:US
Practice Address - Phone:812-239-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty