Provider Demographics
NPI:1699036871
Name:FORREST, KEVIN PATRICK (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:FORREST
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 W 86TH ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2050
Mailing Address - Country:US
Mailing Address - Phone:317-755-2297
Mailing Address - Fax:317-755-2309
Practice Address - Street 1:1717 W 86TH ST
Practice Address - Street 2:SUITE 470
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2050
Practice Address - Country:US
Practice Address - Phone:317-755-2297
Practice Address - Fax:317-755-2309
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002658A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor