Provider Demographics
NPI:1457357147
Name:FORBES, BRIAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:FORBES
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 1:4700 NAMEOKI RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2524
Mailing Address - Country:US
Mailing Address - Phone:618-797-2225
Mailing Address - Fax:618-797-2289
Practice Address - Street 1:4700 NAMEOKI RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2524
Practice Address - Country:US
Practice Address - Phone:618-797-2225
Practice Address - Fax:618-797-2289
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00217167OtherPALMETTO GBA-RR MEDICARE
IL371351522OtherCIGNA, UNITED HEALTHCARE
IL6007286OtherBLUE CROSS BLUE SHIELD
IL204779Medicare ID - Type Unspecified
IL371351522OtherCIGNA, UNITED HEALTHCARE
IL387890Medicare ID - Type Unspecified