Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 272468 | OR |
NPI | 1346298957 |
---|---|
Provider Name | Dr. Theodore L Forcum III |
First Address | Portland, OR 97229-2641 |
Second Address | Astoria, OR 97103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/03/2017 |