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General NPI Number Information
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NPI Number | 1588873434
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Entity Type | Organization
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Legal Business Name | RICHARD G. BOUDREAU, DC P.C
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 3540 COUNTY ROAD 405
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City | NEWBERRY
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State | MI
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Zip | 49868-8138
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Country | US
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Telephone | 906-293-3392
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Fax | 906-293-3411
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Provider Business Mailing Address
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Address Line | 3540 COUNTY ROAD 405
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City | NEWBERRY
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State | MI
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Zip | 49868-8138
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Country | US
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Telephone | 906-293-3392
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Fax | 906-293-3411
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD G BOUDREAU
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Credential | D.C
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Telephone | 906-293-3392
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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 | 2301002053
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License Number State | MI
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