Healthcare Provider Details

I. General information

NPI: 1275010522
Provider Name (Legal Business Name): FORREST ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 TAMPA RD STE A
OLDSMAR FL
34677-3100
US

IV. Provider business mailing address

3906 TAMPA RD STE A
OLDSMAR FL
34677-3100
US

V. Phone/Fax

Practice location:
  • Phone: 813-855-5988
  • Fax: 813-855-6378
Mailing address:
  • Phone: 813-855-5988
  • Fax: 813-855-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4140
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH4140
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT F GOLDEN
Title or Position: OWNER
Credential: D.C.
Phone: 813-855-5986