Provider Demographics
NPI:1770785453
Name:FORSBERG CHIROPRACTIC CLINIC, P.S.
Entity type:Organization
Organization Name:FORSBERG CHIROPRACTIC CLINIC, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-943-6356
Mailing Address - Street 1:325 WELLSIAN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4116
Mailing Address - Country:US
Mailing Address - Phone:509-943-6356
Mailing Address - Fax:509-946-8269
Practice Address - Street 1:325 WELLSIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4116
Practice Address - Country:US
Practice Address - Phone:509-943-6356
Practice Address - Fax:509-946-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202CH00001599111N00000X
WACH00034531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104975358OtherNPI NUMBER
WA1265561039OtherNPI NUMBER
WA8858285Medicare ID - Type Unspecified
WA1265561039OtherNPI NUMBER
WA8858284Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WA8858437Medicare PIN
WA1104975358OtherNPI NUMBER