Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 5724 | TX |
NPI | 1811997364 |
---|---|
Provider Name | Dr. Simon John Forster |
First Address | Austin, TX 78758-2480 |
Second Address | Austin, TX 78758-2480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 26/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011HW | GROUP BCBS # (01) | TX |
432327 | ACN # (01) | TX |
603720 | MEDICARE PTAN (01) | TX |
8F9211 | INDIV BCBS # (01) | TX |
U50691 | (02) | TX |