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General NPI Number Information
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NPI Number | 1861613192
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Entity Type | Organization
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Legal Business Name | BOUDREAU CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 411 US HIGHWAY 9 SUITE 1
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734-2818
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Country | US
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Telephone | 609-971-0101
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Fax | 609-971-0109
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Provider Business Mailing Address
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Address Line | 411 US HIGHWAY 9 SUITE 1
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734-2818
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Country | US
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Telephone | 609-971-0101
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Fax | 609-971-0109
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH TODD BOUDREAU
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Credential | D.C.
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Telephone | 609-971-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00657100
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License Number State | NJ
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