Provider Demographics
NPI:1043541816
Name:FOSTER, CASEY JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JORDAN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 FACTORY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2004
Mailing Address - Country:US
Mailing Address - Phone:502-509-3121
Mailing Address - Fax:
Practice Address - Street 1:13000 FACTORY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2004
Practice Address - Country:US
Practice Address - Phone:502-509-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6109201Medicare PIN