Healthcare Provider Details

I. General information

NPI: 1114282902
Provider Name (Legal Business Name): STACI FOSTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 THE PLZ
TROY MO
63379-1365
US

IV. Provider business mailing address

9 THE PLZ
TROY MO
63379-1365
US

V. Phone/Fax

Practice location:
  • Phone: 636-578-4325
  • Fax: 636-528-4693
Mailing address:
  • Phone: 636-578-4325
  • Fax: 636-528-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20120001578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: