Provider Demographics
NPI:1447314422
Name:FORBACH, THOMAS EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:FORBACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3367
Mailing Address - Country:US
Mailing Address - Phone:913-814-9494
Mailing Address - Fax:913-814-7050
Practice Address - Street 1:14201 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3367
Practice Address - Country:US
Practice Address - Phone:913-814-9494
Practice Address - Fax:913-814-7050
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03367111N00000X
CO5222111N00000X
MO004001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO06154029OtherBLUECROSSBLUESHIELD
KST73573Medicare UPIN
MO06154029OtherBLUECROSSBLUESHIELD