MEDICARE: DR. GINA DIANE FORREST DC

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	111NS0005X	Sports Physician Chiropractor	1058	SC
2	111N00000X	Chiropractor	B01610	NV

General Provider Information

NPI Number	:	1578822805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA DIANE FORREST DC

Provider Business Mailing Address
First Line	:	PO BOX 561564
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80256-1564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1899
Country	:	US
Telephone Number	:	702-577-5829
Fax Number	:

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	01/16/2024

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Directions to “ DR. GINA DIANE FORREST DC” Practice Location

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