Provider Demographics
NPI:1912406810
Name:EMILY FORSGREN DC LLC
Entity type:Organization
Organization Name:EMILY FORSGREN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-970-1273
Mailing Address - Street 1:14805 DETROIT AVE STE 545
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3921
Mailing Address - Country:US
Mailing Address - Phone:216-970-1273
Mailing Address - Fax:
Practice Address - Street 1:14805 DETROIT AVE STE 545
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3921
Practice Address - Country:US
Practice Address - Phone:216-970-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty