Provider Demographics
NPI:1962147512
Name:FORBESS, MICHIRU DANIEL (DC)
Entity type:Individual
Prefix:
First Name:MICHIRU
Middle Name:DANIEL
Last Name:FORBESS
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 1:5300 HIGHLAND DR STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-2000
Mailing Address - Country:US
Mailing Address - Phone:501-916-9470
Mailing Address - Fax:
Practice Address - Street 1:5300 HIGHLAND DR STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-2000
Practice Address - Country:US
Practice Address - Phone:501-916-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor