Provider Demographics
NPI:1932235090
Name:FORZLEY, JEFFREY EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:FORZLEY
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 23
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-0023
Mailing Address - Country:US
Mailing Address - Phone:630-257-0550
Mailing Address - Fax:630-257-0555
Practice Address - Street 1:160 E WEND ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4438
Practice Address - Country:US
Practice Address - Phone:630-257-0550
Practice Address - Fax:630-257-0555
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01682776OtherBCBS
IL211698Medicare ID - Type UnspecifiedMEDICARE