Basic Information
| Provider Information | |||||||||
| NPI: | 1164502175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORS | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1955 130TH AVE | ||||||||
| Address2: | |||||||||
| City: | MORA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550517714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206790298 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 PLYMOUTH RD | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553052366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525410200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NN0400X | 1836 | MN | Y | Chiropractic Providers | Chiropractor | Neurology |
No ID Information.