=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154534485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN A FOSTER DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5912 SPENCER HWY
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77505-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-487-1170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 AUGUSTA DR
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77536-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-476-1747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5549
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------