MEDICARE: DR. EDWARD MACK BOREN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	799	SC

General Provider Information

NPI Number	:	1679658827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MACK BOREN DC

Provider Business Mailing Address
First Line	:	6335 CALHOUN MEMORIAL WAY
Second Line	:	SUITE C
City	:	EASLEY
State	:	SC
Zip	:	29640-3784
Country	:	US
Telephone Number	:	864-859-8282
Fax Number	:	864-859-3628

Provider Business Practice Location Address
First Line	:	6335 CALHOUN MEMORIAL
Second Line	:	SUITE C
City	:	EASLEY
State	:	SC
Zip	:	29640-3784
Country	:	US
Telephone Number	:	864-859-8282
Fax Number	:	864-859-3628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. EDWARD MACK BOREN DC” Practice Location

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