Provider Demographics
NPI:1558606400
Name:FORE CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:FORE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-336-9044
Mailing Address - Street 1:200 FOREST AVE E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1581
Mailing Address - Country:US
Mailing Address - Phone:320-679-8996
Mailing Address - Fax:320-679-6961
Practice Address - Street 1:200 FOREST AVE E
Practice Address - Street 2:SUITE 2
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1581
Practice Address - Country:US
Practice Address - Phone:320-679-8996
Practice Address - Fax:320-679-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty