Provider Demographics
NPI:1790382828
Name:FORSYTH, ANTONIA JULIETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:JULIETTE
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HITCHCOCK WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6157
Mailing Address - Country:US
Mailing Address - Phone:805-618-2125
Mailing Address - Fax:
Practice Address - Street 1:23 HITCHCOCK WAY STE 110
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6157
Practice Address - Country:US
Practice Address - Phone:805-618-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor