MEDICARE: DR. MICA VONNE FOSTER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3612	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3612	OTHER	OR	OREGON LICENSE NUMBER

General Provider Information

NPI Number	:	1306981220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICA VONNE FOSTER DC

Provider Business Mailing Address
First Line	:	1012 CASCADE AVE
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1402
Country	:	US
Telephone Number	:	541-993-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 WASHINGTON ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2232
Country	:	US
Telephone Number	:	541-993-7003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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