=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770724858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD C. ANDERSON D.C.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 FRANKLIN ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21613-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-901-2903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 FRANKLIN ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21613-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-901-2903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. EDWARD ANDERSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 410-901-2903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S 02047
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------