Provider Demographics
NPI:1508165275
Name:PELTAN, FOREST GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:FOREST
Middle Name:GENE
Last Name:PELTAN
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 1:2005 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5141
Mailing Address - Country:US
Mailing Address - Phone:512-971-7746
Mailing Address - Fax:512-447-5433
Practice Address - Street 1:2005 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5141
Practice Address - Country:US
Practice Address - Phone:512-971-7746
Practice Address - Fax:512-447-5433
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor