Provider Demographics
NPI:1063509396
Name:FOSTER, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 BONITA BEACH RD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4278
Mailing Address - Country:US
Mailing Address - Phone:239-390-0607
Mailing Address - Fax:239-390-0601
Practice Address - Street 1:9200 BONITA BEACH RD SE STE 203
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4278
Practice Address - Country:US
Practice Address - Phone:239-390-0607
Practice Address - Fax:239-390-0601
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF185ZMedicare PIN