MEDICARE: DR. BRIAN M FORBES D.C.

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	111N00000X	Chiropractor	038-007852	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00217167	OTHER	IL	PALMETTO GBA-RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	371351522	OTHER	IL	CIGNA, UNITED HEALTHCARE
3	6007286	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457357147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN M FORBES D.C.

Provider Business Mailing Address
First Line	:	4700 NAMEOKI RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-2524
Country	:	US
Telephone Number	:	618-797-2225
Fax Number	:	618-797-2289

Provider Business Practice Location Address
First Line	:	4700 NAMEOKI RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-2524
Country	:	US
Telephone Number	:	618-797-2225
Fax Number	:	618-797-2289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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