=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407058795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMOSKEAG CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 AMOSKEAG ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03102-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-624-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 AMOSKEAG STREET
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-624-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | EDWARD J RUSHER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-624-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | NH111-1092
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------