Provider Demographics
NPI:1720345051
Name:FORRED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FORRED CHIROPRACTIC LLC
Other - Org Name:FORRED CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:FORRED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-492-8000
Mailing Address - Street 1:10111 E 21ST ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3508
Mailing Address - Country:US
Mailing Address - Phone:316-315-0220
Mailing Address - Fax:316-315-0440
Practice Address - Street 1:10111 E 21ST ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3508
Practice Address - Country:US
Practice Address - Phone:316-315-0220
Practice Address - Fax:316-315-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty