Provider Demographics
NPI:1730141854
Name:FORBES, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:FORBES
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:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:IL
Mailing Address - Zip Code:61537
Mailing Address - Country:US
Mailing Address - Phone:309-364-3398
Mailing Address - Fax:309-364-2059
Practice Address - Street 1:322 EDWARD STREET
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537
Practice Address - Country:US
Practice Address - Phone:309-364-3398
Practice Address - Fax:309-364-2059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5876061OtherAETNA
IL3782008OtherBCBS
IL3782008OtherBCBS
IL216620Medicare ID - Type Unspecified