MEDICARE: DR. FORREST FIX 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	4703	CO

General Provider Information

NPI Number	:	1619011913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORREST FIX D.C.

Provider Business Mailing Address
First Line	:	3220 N ACADEMY BLVD STE 6
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	303-350-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 N ACADEMY BLVD STE 6
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	303-350-0976
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	04/18/2008

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