Healthcare Provider Details

I. General information

NPI: 1780874099
Provider Name (Legal Business Name): JUSTIN D. FOSTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400B RANGELINE RD
MOBILE AL
36619-9534
US

IV. Provider business mailing address

4400B RANGELINE RD
MOBILE AL
36619-9534
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 Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number1621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: