Healthcare Provider Details

I. General information

NPI: 1427149947
Provider Name (Legal Business Name): FOSTER CHIROPRACTIC GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 B RANGELINE RD
MOBILE AL
36619
US

IV. Provider business mailing address

4400 B RANGELINE RD
MOBILE AL
36619
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-2100
  • Fax: 251-661-2258
Mailing address:
  • Phone: 251-661-2100
  • Fax: 251-661-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberLIC1621
License Number StateAL

VIII. Authorized Official

Name: DR. JUSTIN D FOSTER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 251-661-2100