=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639249998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN CRAIG BOESCHE D.C. WITH PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 10/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13890 FORSYTHE RD
-----------------------------------------------------
City | SYKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-5811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-442-8088
-----------------------------------------------------
Fax | 410-442-1547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 325
-----------------------------------------------------
City | WEST FRIENDSHIP
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21794-0325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-442-8088
-----------------------------------------------------
Fax | 410-442-1547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 01221
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------