=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891877155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY ALEXANDER BOSHMAN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32221 CAMINO CAPISTRANO SUITE B106
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-493-4141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32221 CAMINO CAPISTRANO SUITE B106
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-493-4141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 13945
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------