Provider Demographics
NPI:1265650444
Name:FOSTER CHIROPRACTIC & WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:FOSTER CHIROPRACTIC & WELLNESS CENTER, PLLC
Other - Org Name:FOSTER HEALTH & WELLNESS CENTER, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-678-8300
Mailing Address - Street 1:630 15TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2764
Mailing Address - Country:US
Mailing Address - Phone:303-678-8300
Mailing Address - Fax:303-651-2556
Practice Address - Street 1:630 15TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2764
Practice Address - Country:US
Practice Address - Phone:303-678-8300
Practice Address - Fax:303-651-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4345111N00000X
261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4579Medicare PIN