Provider Demographics
NPI:1992883839
Name:FOSTER, LORI RENEE' (DC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENEE'
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 1:588 WILLIAM R LATHAM SR DR
Mailing Address - Street 2:SUIT 5
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2326
Mailing Address - Country:US
Mailing Address - Phone:815-932-7800
Mailing Address - Fax:815-932-7806
Practice Address - Street 1:588 WILLIAM R LATHAM SR DR
Practice Address - Street 2:SUIT 5
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2326
Practice Address - Country:US
Practice Address - Phone:815-932-7800
Practice Address - Fax:815-932-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04632068OtherBC/BC OF ILLINOIS
IL04632068OtherBC/BC OF ILLINOIS
ILU40476Medicare UPIN