MEDICARE: FORLENZA DECOMPRESSION CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1194913418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORLENZA DECOMPRESSION CORPORATION

Provider Business Mailing Address
First Line	:	71 CAVALIER BLVD STE 319
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-5172
Country	:	US
Telephone Number	:	859-393-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 CAVALIER BLVD STE 319
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-5172
Country	:	US
Telephone Number	:	859-393-5905
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL FORLENZA
Credential	:	D.C.
Telephone Number	:	859-393-5905

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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