Provider Demographics
NPI:1598090219
Name:FORRESTER, STEPHEN D
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:FORRESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 MINERAL WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4904
Mailing Address - Country:US
Mailing Address - Phone:731-676-0134
Mailing Address - Fax:
Practice Address - Street 1:1024 MINERAL WELLS AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4904
Practice Address - Country:US
Practice Address - Phone:731-644-9000
Practice Address - Fax:731-644-9006
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor