NPIMap

Organization Active NPI

Hazel Dell Sports Medicine & Rehab Clinic PLLC

Doing business as Forgey SportsMed & Rehab Clinic

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1902930076
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
HAZEL DELL SPORTS MEDICINE & REHAB CLINIC PLLC
Doing business as
Forgey SportsMed & Rehab Clinic
Practice address
300 Grand Blvd
Ste B200
Vancouver, WA 98661-4930
Phone
(360) 573-5500
Fax
(360) 573-9075
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Douglas Lee Forgey, DCNPI 1720083843
Title
Owner
Phone
(360) 573-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X WA Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD00010276 WA

Addresses

Primary practice location

300 Grand Blvd
Ste B200
Vancouver, WA 98661-4930

Mailing address

300 Grand Blvd
Ste B200
Vancouver, WA 98661-4930
Phone (360) 573-5500

Other identifiers 1

IdentifierTypeStateIssuer
0154878OtherWADEPARTMENT OF LABOR & IND

Other names 1

  • Forgey SportsMed & Rehab Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1902930076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 GRAND BLVD",
            "address_2": "STE B200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986614930",
            "telephone_number": "360-573-5500",
            "fax_number": "360-573-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GRAND BLVD",
            "address_2": "STE B200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986614930",
            "telephone_number": "360-573-5500",
            "fax_number": "360-573-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL DELL SPORTS MEDICINE & REHAB CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "FORGEY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-573-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00010276",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & IND",
            "identifier": "0154878",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forgey SportsMed & Rehab Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.