Provider Demographics
NPI:1487680708
Name:FORBES, BRADLEY (DC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
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 1:40 N CENTRAL AVE STE 775
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4413
Mailing Address - Country:US
Mailing Address - Phone:602-889-5833
Mailing Address - Fax:602-889-5834
Practice Address - Street 1:40 N CENTRAL AVE STE 775
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4413
Practice Address - Country:US
Practice Address - Phone:602-889-5833
Practice Address - Fax:602-889-5834
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor