MEDICARE: BOBBY JOE FORSYTH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B964	NV

General Provider Information

NPI Number	:	1811183270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY JOE FORSYTH D.C.

Provider Business Mailing Address
First Line	:	5288 SPRING MOUNTAIN RD
Second Line	:	SUITE 250
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8723
Country	:	US
Telephone Number	:	702-248-1881
Fax Number	:	702-248-3886

Provider Business Practice Location Address
First Line	:	5288 SPRING MOUNTAIN RD
Second Line	:	SUITE 250
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8723
Country	:	US
Telephone Number	:	702-248-1881
Fax Number	:	702-248-3886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	01/20/2009

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