Healthcare Provider Details

I. General information

NPI: 1801644372
Provider Name (Legal Business Name): FOREVER FIT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W 7TH AVE STE A
EUGENE OR
97402-5117
US

IV. Provider business mailing address

825 W 7TH AVE STE A
EUGENE OR
97402-5117
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-2225
  • Fax: 541-484-2128
Mailing address:
  • Phone: 541-484-2225
  • Fax: 541-484-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JERRY EVANS
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 541-484-2225