Provider Demographics
NPI:1386219566
Name:FORSBERG, ERIC VON (I-MD, TND, PHD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:VON
Last Name:FORSBERG
Suffix:
Gender:M
Credentials:I-MD, TND, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W HIGHWAY 14 # 1671
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1148
Mailing Address - Country:US
Mailing Address - Phone:530-602-3099
Mailing Address - Fax:
Practice Address - Street 1:21435 WILCOX RD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-7962
Practice Address - Country:US
Practice Address - Phone:530-567-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4522253175F00000X
A2038449146M00000X
CA191092164X00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach