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General NPI Number Information
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NPI Number | 1144592510
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Entity Type | Organization
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Legal Business Name | FORWARD CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 540 HARTBROOK DR STE B
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City | HARTLAND
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State | WI
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Zip | 53029-1400
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Country | US
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Telephone | 608-778-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 540 HARTBROOK DR STE B
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City | HARTLAND
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State | WI
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Zip | 53029-1400
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Country | US
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Telephone | 608-778-2404
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SETH ANDREW BARR
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Credential | D.C.
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Telephone | 608-778-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4811-12
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License Number State | WI
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