Provider Demographics
NPI:1669436630
Name:FORMAN, CATHERINE RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:RUTH
Last Name:FORMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8834 KEENEY RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9305
Mailing Address - Country:US
Mailing Address - Phone:585-768-6969
Mailing Address - Fax:585-768-7679
Practice Address - Street 1:8834 KEENEY RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9305
Practice Address - Country:US
Practice Address - Phone:585-768-6969
Practice Address - Fax:585-768-7679
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAN101864OtherPREFERRED CARE
NY012941Medicare ID - Type Unspecified