Provider Demographics
NPI:1396905238
Name:FORWARD, TERRY L (DC/QME)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:FORWARD
Suffix:
Gender:F
Credentials:DC/QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HARDING ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1818
Mailing Address - Country:US
Mailing Address - Phone:760-729-1805
Mailing Address - Fax:760-448-6125
Practice Address - Street 1:2945 HARDING ST STE 108
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1818
Practice Address - Country:US
Practice Address - Phone:760-729-1805
Practice Address - Fax:760-448-6125
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12403111NI0013X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0124030OtherBLUE SHIELD
CADC124030OtherMEDICARE PTAN