Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 12403 | CA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 12403 | CA |
NPI | 1396905238 |
---|---|
Provider Name | Dr. Terry L Forward |
First Address | Carlsbad, CA 92008-1818 |
Second Address | Carlsbad, CA 92008-1818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 30/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0124030 | BLUE SHIELD (01) | CA |
DC124030 | MEDICARE PTAN (01) | CA |