Provider Demographics
NPI:1639249998
Name:BOESCHE, STEVEN CRAIG (DC WITH PT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CRAIG
Last Name:BOESCHE
Suffix:
Gender:M
Credentials:DC WITH PT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-0325
Mailing Address - Country:US
Mailing Address - Phone:410-442-8088
Mailing Address - Fax:410-442-1547
Practice Address - Street 1:13890 FORSYTHE RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5811
Practice Address - Country:US
Practice Address - Phone:410-442-8088
Practice Address - Fax:410-442-1547
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01221111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35118401OtherPROFESSIONAL RENDERING
MHF5160001OtherBLUE CHOICE
MDKAH5OtherBLUE CROSS CAREFIRST
MD35118401OtherPROFESSIONAL RENDERING