Provider Demographics
NPI:1730114679
Name:FORBES, TYLER S (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:S
Last Name:FORBES
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 1:11199 SORRENTO VALLEY ROAD
Mailing Address - Street 2:201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1334
Mailing Address - Country:US
Mailing Address - Phone:858-768-6111
Mailing Address - Fax:858-768-6116
Practice Address - Street 1:11199 SORRENTO VALLEY ROAD
Practice Address - Street 2:201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-768-6111
Practice Address - Fax:858-768-6116
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC26282AMedicare ID - Type Unspecified
CAV05850Medicare UPIN
CAFL666ZMedicare PIN