Provider Demographics
NPI:1619011913
Name:FIX, FORREST (DC)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:
Last Name:FIX
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 1:3220 N ACADEMY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5115
Mailing Address - Country:US
Mailing Address - Phone:303-350-0976
Mailing Address - Fax:
Practice Address - Street 1:3220 N ACADEMY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:303-350-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC47993Medicare PIN