Provider Demographics
NPI:1902835432
Name:FOSTER, ADAM JAY (DC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JAY
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 1:514 SAINT JAMES AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2767
Mailing Address - Country:US
Mailing Address - Phone:843-824-1777
Mailing Address - Fax:843-824-1779
Practice Address - Street 1:514 SAINT JAMES AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2767
Practice Address - Country:US
Practice Address - Phone:843-824-1777
Practice Address - Fax:843-824-1779
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2544Medicaid
SC8196Medicare PIN
SCCH2544Medicaid