Provider Demographics
NPI:1295384584
Name:100 PERCENT CHIROPRACTIC FOSTER LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC FOSTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-571-1203
Mailing Address - Street 1:3625 DALLAS HWY SW STE 850
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5925
Mailing Address - Country:US
Mailing Address - Phone:678-571-1203
Mailing Address - Fax:
Practice Address - Street 1:3625 DALLAS HWY
Practice Address - Street 2:SUITE 850
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3121
Practice Address - Country:US
Practice Address - Phone:678-571-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty