Provider Demographics
NPI:1265433817
Name:FOREMAN, JOHN EVERETT (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EVERETT
Last Name:FOREMAN
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 1:911 ADELE AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3521
Mailing Address - Country:US
Mailing Address - Phone:360-377-3751
Mailing Address - Fax:360-405-1677
Practice Address - Street 1:911 ADELE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3521
Practice Address - Country:US
Practice Address - Phone:360-377-3751
Practice Address - Fax:360-405-1677
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0080053OtherLABOR & INDUSTRIES
WA0080053OtherLABOR & INDUSTRIES
WA000201008Medicare ID - Type Unspecified