=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265444210
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FOSTER JAMES CULLUM IV D.C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 02/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3728 PHILLIPS HWY STE 13
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-6840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-477-4480
-----------------------------------------------------
Fax | 904-683-5619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 47125
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32247-7125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-477-4480
-----------------------------------------------------
Fax | 904-683-5619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH7576
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------