Healthcare Provider Details

I. General information

NPI: 1164502175
Provider Name (Legal Business Name): GREGORY CHARLES FORS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PLYMOUTH RD
MINNETONKA MN
55305-2366
US

IV. Provider business mailing address

1955 130TH AVE
MORA MN
55051-7714
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-0200
  • Fax:
Mailing address:
  • Phone: 320-679-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1836
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: