Individual
MARY LEE FORTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
6642 PENN AVE S, RICHFIELD, MN 55423-2026
(612) 670-5790
(612) 861-2752
Mailing address
6642 PENN AVE S, RICHFIELD, MN 55423-2026
(612) 670-5790
(612) 861-2752
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2535
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69D52FO
BCBS INDIVIDUAL PROVIDER
MN
Enumeration date
09/20/2006
Last updated
07/08/2007
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