Provider Demographics
NPI:1477617819
Name:FORBES, BRAD LEE (DC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:LEE
Last Name:FORBES
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 1:11711 JEFFERSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2062
Mailing Address - Country:US
Mailing Address - Phone:757-594-9820
Mailing Address - Fax:757-594-9823
Practice Address - Street 1:11711 JEFFERSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2062
Practice Address - Country:US
Practice Address - Phone:757-594-9820
Practice Address - Fax:757-594-9823
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0007781552OtherAETNA PIN
VA136843OtherANTHEM BLUE CROSS BLUE SH