Provider Demographics
NPI:1366572984
Name:FORTE, NICHOLAS A JR (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:FORTE
Suffix:JR
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 1:16 WATERBURY RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1215
Mailing Address - Country:US
Mailing Address - Phone:203-758-3391
Mailing Address - Fax:203-758-0358
Practice Address - Street 1:16 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1215
Practice Address - Country:US
Practice Address - Phone:203-758-3391
Practice Address - Fax:203-758-0358
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor