Provider Demographics
NPI:1265561039
Name:FORSBERG, STEVEN JOHN (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:FORSBERG
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 1:325 WELLSIAN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4116
Mailing Address - Country:US
Mailing Address - Phone:509-943-6356
Mailing Address - Fax:509-946-8269
Practice Address - Street 1:325 WELLSIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4116
Practice Address - Country:US
Practice Address - Phone:509-943-6356
Practice Address - Fax:509-946-8269
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02295Medicare UPIN
8858284Medicare ID - Type Unspecified