Provider Demographics
NPI:1780874099
Name:FOSTER, JUSTIN D (DC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:D
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 1:4400B RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9534
Mailing Address - Country:US
Mailing Address - Phone:251-661-2100
Mailing Address - Fax:251-661-2258
Practice Address - Street 1:4400B RANGELINE RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9534
Practice Address - Country:US
Practice Address - Phone:251-661-2100
Practice Address - Fax:251-661-2258
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1621111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000-75172OtherPROVIDER
ALU56293Medicare UPIN