Provider Demographics
NPI:1912964982
Name:FOSTER, STEPHEN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
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 1:2340 E CALVADA BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048
Mailing Address - Country:US
Mailing Address - Phone:775-727-0888
Mailing Address - Fax:775-727-2362
Practice Address - Street 1:2340 E CALVADA BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:775-727-0888
Practice Address - Fax:775-727-2362
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV30628Medicare ID - Type Unspecified
U57529Medicare UPIN