Provider Demographics
NPI:1811997364
Name:FORSTER, SIMON JOHN (DC, DABCO)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:JOHN
Last Name:FORSTER
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12414 ALDERBROOK DR
Mailing Address - Street 2:STE. 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2480
Mailing Address - Country:US
Mailing Address - Phone:512-834-2355
Mailing Address - Fax:512-834-0477
Practice Address - Street 1:12414 ALDERBROOK DR
Practice Address - Street 2:STE. 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2480
Practice Address - Country:US
Practice Address - Phone:512-834-2355
Practice Address - Fax:512-834-0477
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5724111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603720OtherMEDICARE PTAN
TX8F9211OtherINDIV BCBS #
TX432327OtherACN #
TX0011HWOtherGROUP BCBS #
TX0011HWOtherGROUP BCBS #