Provider Demographics
NPI:1265472187
Name:FOSTER, GEORGE MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MARK
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WESTGATE MALL DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301
Mailing Address - Country:US
Mailing Address - Phone:864-587-9226
Mailing Address - Fax:864-587-9226
Practice Address - Street 1:220 WESTGATE MALL DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301
Practice Address - Country:US
Practice Address - Phone:864-587-9226
Practice Address - Fax:864-587-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1996Medicaid