Provider Demographics
NPI:1548214638
Name:COYKENDALL, FORREST SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:SCOTT
Last Name:COYKENDALL
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 1:2050 LATTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3734
Mailing Address - Country:US
Mailing Address - Phone:585-621-2540
Mailing Address - Fax:585-621-2591
Practice Address - Street 1:2050 LATTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3734
Practice Address - Country:US
Practice Address - Phone:585-621-2540
Practice Address - Fax:585-621-2591
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB0068Medicare PIN
NYU26341Medicare UPIN