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General NPI Number Information
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NPI Number | 1134542517
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Entity Type | Organization
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Legal Business Name | BOUCHARD CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 27322 23 MILE RD SUITE 3
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2032
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Country | US
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Telephone | 586-231-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 12839 CHIPPEWA DR
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City | WARREN
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State | MI
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Zip | 48088-1816
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Country | US
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Telephone | 248-767-2183
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. KRISTY SUE BOUCHARD
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Credential | D.C.
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Telephone | 248-767-2183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2324558
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License Number State | MI
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