Provider Demographics
NPI:1477576007
Name:FOSTER, GRANT STERLING (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:STERLING
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 1:4380 FELTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1421
Mailing Address - Country:US
Mailing Address - Phone:619-283-6001
Mailing Address - Fax:619-283-1272
Practice Address - Street 1:4380 FELTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1421
Practice Address - Country:US
Practice Address - Phone:619-283-6001
Practice Address - Fax:619-283-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-17137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18484Medicare UPIN