Healthcare Provider Details

I. General information

NPI: 1093337420
Provider Name (Legal Business Name): FORWARD SPINE & SPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMONWEALTH AVE STE G1
BOSTON MA
02215-2813
US

IV. Provider business mailing address

400 COMMONWEALTH AVE STE G1
BOSTON MA
02215-2813
US

V. Phone/Fax

Practice location:
  • Phone: 617-580-2822
  • Fax: 855-741-0559
Mailing address:
  • Phone: 617-580-2822
  • Fax: 850-741-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN MORAN KENT
Title or Position: OWNER
Credential: DC, L.AC.
Phone: 585-410-2081