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General NPI Number Information
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NPI Number | 1184871923
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Entity Type | Organization
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Legal Business Name | BOUTWELL CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 08/23/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 3434 UNIVERSITY AVE.
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City | COLUMBUS
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State | GA
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Zip | 31907
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Country | US
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Telephone | 706-569-6997
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Fax | 706-569-8898
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Provider Business Mailing Address
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Address Line | 3434 UNIVERSITY AVE.
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City | COLUMBUS
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State | GA
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Zip | 31907
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Country | US
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Telephone | 706-569-6997
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Fax | 706-569-8898
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROGER BERT BOUTWELL
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Credential | DC
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Telephone | 706-566-6996
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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 | CHIR001984
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License Number State | GA
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