Provider Demographics
NPI:1649864265
Name:REDWOOD, FORREST GOWEN (DC)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:GOWEN
Last Name:REDWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:FORREST
Other - Middle Name:EDWARD
Other - Last Name:GOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14115 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2628
Mailing Address - Country:US
Mailing Address - Phone:503-841-6633
Mailing Address - Fax:
Practice Address - Street 1:14115 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2628
Practice Address - Country:US
Practice Address - Phone:503-841-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor