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General NPI Number Information
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NPI Number | 1144883000
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Entity Type | Organization
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Legal Business Name | FORGE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 5424 1ST AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35212-2404
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Country | US
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Telephone | 205-407-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 5424 1ST AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35212-2404
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Country | US
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Telephone | 205-407-5245
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Fax |
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Authorized Official
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Title or Position | INS. SPECIALIST
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Name | MRS. PAULA S SHANNON
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Credential |
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Telephone | 770-982-4886
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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 |
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License Number State |
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