=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235149915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN DRUCKER DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 NW 15TH STREET #102A
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-392-7989
-----------------------------------------------------
Fax | 561-392-7984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 NW 15TH STREET #102A
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-392-7989
-----------------------------------------------------
Fax | 561-392-7984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH3701
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------