Provider Demographics
NPI:1750999124
Name:FOSTER, BROOK (DC)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
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:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor