Healthcare Provider Details

I. General information

NPI: 1104161744
Provider Name (Legal Business Name): HEATH GILMAN FOSTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2012
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 RIVER ST
SPRINGFIELD VT
05156-2242
US

IV. Provider business mailing address

1880 CHARLES HENNESSEE RD
SPARTA TN
38583-2768
US

V. Phone/Fax

Practice location:
  • Phone: 802-886-2555
  • Fax:
Mailing address:
  • Phone: 309-318-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006.0125754
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: