Provider Demographics
NPI:1588600597
Name:FOSTER FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FOSTER FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-238-6686
Mailing Address - Street 1:10963 VAN WERT DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9211
Mailing Address - Country:US
Mailing Address - Phone:419-238-6686
Mailing Address - Fax:419-238-6201
Practice Address - Street 1:10963 VAN WERT DECATUR RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9211
Practice Address - Country:US
Practice Address - Phone:419-238-6686
Practice Address - Fax:419-238-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH536770OtherGROUP PTAN