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General NPI Number Information
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NPI Number | 1861725715
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Entity Type | Individual
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Provider Name | PATRICIA BOULOGNE
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Gender | Female
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 148 QUINCY SHORE DR APT 29
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City | QUINCY
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State | MA
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Zip | 02171-2930
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Country | US
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Telephone | 617-901-0925
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Fax |
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Provider Business Mailing Address
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Address Line | 148 QUINCY SHORE DR APT 29
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City | QUINCY
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State | MA
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Zip | 02171-2930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 935
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 935
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License Number State | MA
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