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General NPI Number Information
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NPI Number | 1225356835
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Entity Type | Organization
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Legal Business Name | BOUDREAUX SPINE & JOINT
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 309 GOODE ST SUITE 2D
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City | HOUMA
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State | LA
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Zip | 70360-4562
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Country | US
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Telephone | 504-338-6042
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Fax | 985-447-9578
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Provider Business Mailing Address
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Address Line | 309 GOODE ST SUITE 2D
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City | HOUMA
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State | LA
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Zip | 70360-4562
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Country | US
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Telephone | 504-338-6042
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Fax | 985-447-9578
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JONATHAN JAMES BOUDREAUX
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Credential | DC
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Telephone | 504-338-6042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1496
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License Number State | LA
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