Provider Demographics
NPI:1841322443
Name:FORLENZA, SAMUEL JR (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:FORLENZA
Suffix:JR
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-0414
Mailing Address - Country:US
Mailing Address - Phone:859-393-5905
Mailing Address - Fax:859-291-5774
Practice Address - Street 1:1671 PARK RD
Practice Address - Street 2:SUITE 14
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2769
Practice Address - Country:US
Practice Address - Phone:859-393-5905
Practice Address - Fax:859-291-5774
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6106001Medicare ID - Type Unspecified