Provider Demographics
NPI:1588746879
Name:FOSTER, BRIAN KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:FOSTER
Suffix:
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 1:630 15TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2764
Mailing Address - Country:US
Mailing Address - Phone:303-678-8300
Mailing Address - Fax:303-651-2556
Practice Address - Street 1:630 15TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2700
Practice Address - Country:US
Practice Address - Phone:303-678-8300
Practice Address - Fax:303-651-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4345111N00000X, 111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4579Medicare PIN
COCO40891Medicare PIN