Healthcare Provider Details

I. General information

NPI: 1053474502
Provider Name (Legal Business Name): ANDRA SCHMIDT FOSTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S INDEPENDENCE BLVD SUITE 105
VIRGINIA BEACH VA
23452-1150
US

IV. Provider business mailing address

5313 BALFOR DR
VIRGINIA BEACH VA
23464-2406
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-2273
  • Fax: 757-490-6001
Mailing address:
  • Phone: 757-490-2273
  • Fax: 747-490-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104001244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: