Provider Demographics
NPI:1801289061
Name:FOREST, DANIEL (DC, CLS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FOREST
Suffix:
Gender:M
Credentials:DC, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 COON RAPIDS NWBLVD
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4755
Mailing Address - Country:US
Mailing Address - Phone:651-323-8954
Mailing Address - Fax:
Practice Address - Street 1:116 CHESTNUT ST E
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5116
Practice Address - Country:US
Practice Address - Phone:651-323-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor