Provider Demographics
NPI:1720350036
Name:FORRED, JOSEPH WESLEY (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WESLEY
Last Name:FORRED
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 1:7602 E HARRY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3128
Mailing Address - Country:US
Mailing Address - Phone:316-773-1212
Mailing Address - Fax:316-440-6601
Practice Address - Street 1:8780 MASTIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4770
Practice Address - Country:US
Practice Address - Phone:913-492-8000
Practice Address - Fax:913-492-4111
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor