Healthcare Provider Details

I. General information

NPI: 1265650444
Provider Name (Legal Business Name): FOSTER CHIROPRACTIC & WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 15TH AVE SUITE 102
LONGMONT CO
80501-2764
US

IV. Provider business mailing address

630 15TH AVE SUITE 102
LONGMONT CO
80501-2764
US

V. Phone/Fax

Practice location:
  • Phone: 303-678-8300
  • Fax: 303-651-2556
Mailing address:
  • Phone: 303-678-8300
  • Fax: 303-651-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4345
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN K FOSTER
Title or Position: OWNER
Credential: D.C.
Phone: 303-678-8300