Provider Demographics
NPI:1710259742
Name:FRIENDSHIP CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FRIENDSHIP CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOESCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-442-8088
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:12800 FREDERICK ROAD
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDSHIP CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01221111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF516-0001OtherBLUE CROSS
MD1639249998OtherNPI TYPE 1
MDF516-0001OtherBLUE CROSS