Provider Demographics
NPI:1922187897
Name:FOSTER, CHARLES L (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
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 1:30 MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-1120
Mailing Address - Country:US
Mailing Address - Phone:802-247-6464
Mailing Address - Fax:802-247-5615
Practice Address - Street 1:30 MARBLE ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-1120
Practice Address - Country:US
Practice Address - Phone:802-247-6464
Practice Address - Fax:802-247-5615
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT060000789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009183Medicaid
VT035-6530OtherBLUE CROSS BLUE SHIELD
VT0009183Medicaid
VTT25471Medicare UPIN