Provider Demographics
NPI:1922186469
Name:FORSSTROM, DOUGLAS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:FORSSTROM
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 1:8100 S. QUEBEC STREET
Mailing Address - Street 2:SUITE B17
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3100
Mailing Address - Country:US
Mailing Address - Phone:303-770-5666
Mailing Address - Fax:303-713-1130
Practice Address - Street 1:8100 S. QUEBEC ST.
Practice Address - Street 2:SUITE B17
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3100
Practice Address - Country:US
Practice Address - Phone:303-770-5666
Practice Address - Fax:303-713-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC22073Medicare PIN