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General NPI Number Information
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NPI Number | 1871879965
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Entity Type | Organization
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Legal Business Name | S J BOUTIN D C PLLC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 7410 NEW LAGRANGE RD 304
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City | LOUISVILLE
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State | KY
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Zip | 40222-4871
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Country | US
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Telephone | 502-426-1330
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Fax | 504-426-1337
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Provider Business Mailing Address
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Address Line | 7410 NEW LAGRANGE RD STE 304
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City | LOUISVILLE
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State | KY
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Zip | 40222-4871
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Country | US
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Telephone | 502-426-1330
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Fax | 504-426-1337
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STEPHEN JACQUES BOUTIN
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Credential | DC
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Telephone | 502-426-1330
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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 | 4471
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License Number State | KY
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