Provider Demographics
NPI:1679658827
Name:BOREN, EDWARD MACK (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MACK
Last Name:BOREN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ED
Other - Middle Name:
Other - Last Name:BOREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6335 CALHOUN MEMORIAL WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3784
Mailing Address - Country:US
Mailing Address - Phone:864-859-8282
Mailing Address - Fax:864-859-3628
Practice Address - Street 1:6335 CALHOUN MEMORIAL
Practice Address - Street 2:SUITE C
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3784
Practice Address - Country:US
Practice Address - Phone:864-859-8282
Practice Address - Fax:864-859-3628
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T24640Medicare UPIN