Provider Demographics
NPI:1346429685
Name:FOSS, DAVID LIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LIN
Last Name:FOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:108 VALLEY DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8872
Mailing Address - Country:US
Mailing Address - Phone:630-365-9887
Mailing Address - Fax:630-365-9879
Practice Address - Street 1:108 VALLEY DR
Practice Address - Street 2:SUITE F
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8872
Practice Address - Country:US
Practice Address - Phone:630-365-9887
Practice Address - Fax:630-365-9879
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU83863Medicare UPIN
IL631960Medicare PIN