Provider Demographics
NPI:1992802078
Name:FORTE CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:FORTE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-670-5790
Mailing Address - Street 1:6642 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2026
Mailing Address - Country:US
Mailing Address - Phone:612-670-5790
Mailing Address - Fax:612-861-2752
Practice Address - Street 1:6642 PENN AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2026
Practice Address - Country:US
Practice Address - Phone:612-670-5790
Practice Address - Fax:612-861-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN69D51FOOtherBCBS CLINIC NUMBER