Provider Demographics
NPI:1295941342
Name:FOSTER CHIROPRACTIC S.C
Entity type:Organization
Organization Name:FOSTER CHIROPRACTIC S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-932-7800
Mailing Address - Street 1:588 WILLIAM R LATHAM SR DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2326
Mailing Address - Country:US
Mailing Address - Phone:815-932-7800
Mailing Address - Fax:815-932-7806
Practice Address - Street 1:588 WILLIAM R LATHAM SR DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2326
Practice Address - Country:US
Practice Address - Phone:815-932-7800
Practice Address - Fax:815-932-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU40476Medicare UPIN
IL213532Medicare ID - Type Unspecified