=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710259742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIENDSHIP CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2012
-----------------------------------------------------
Last Update Date | 02/07/2012
-----------------------------------------------------
=====================================================
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 12800 FREDERICK ROAD
-----------------------------------------------------
City | WEST FRIENDSHIP
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21794-0325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-442-8088
-----------------------------------------------------
Fax | 410-442-1547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN C BOESCHE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 410-442-8088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | S01221
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------