Healthcare Provider Details

I. General information

NPI: 1417026774
Provider Name (Legal Business Name): THOMAS RALEIGH FORREST JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 32ND ST
LUMBERTON NC
28358-2925
US

IV. Provider business mailing address

102 W 32ND ST
LUMBERTON NC
28358-2925
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-7710
  • Fax: 910-738-7749
Mailing address:
  • Phone: 910-738-7710
  • Fax: 910-738-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberNC2827
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: