Provider Demographics
NPI:1154383677
Name:FORRESTER, GEORGE RANDALL (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RANDALL
Last Name:FORRESTER
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 1:875 W ASHLAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4742
Mailing Address - Country:US
Mailing Address - Phone:559-292-6191
Mailing Address - Fax:559-292-6193
Practice Address - Street 1:875 W ASHLAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4742
Practice Address - Country:US
Practice Address - Phone:559-292-6191
Practice Address - Fax:559-292-6193
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0163780OtherMEDICARE PIN NUMBER
CADC0163780OtherMEDICARE PIN NUMBER