Provider Demographics
NPI:1427149947
Name:FOSTER CHIROPRACTIC GROUP, PC
Entity type:Organization
Organization Name:FOSTER CHIROPRACTIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-661-2100
Mailing Address - Street 1:4400 B RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619
Mailing Address - Country:US
Mailing Address - Phone:251-661-2100
Mailing Address - Fax:251-661-2258
Practice Address - Street 1:4400 B RANGELINE RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619
Practice Address - Country:US
Practice Address - Phone:251-661-2100
Practice Address - Fax:251-661-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLIC1621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56293Medicare UPIN
AL000075172Medicare ID - Type Unspecified