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General NPI Number Information
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NPI Number | 1922145812
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Entity Type | Organization
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Legal Business Name | BOUTWELL CHIROPRACTIC GROUP PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 3665 WHEELER RD SUITE 2A
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City | AUGUSTA
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State | GA
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Zip | 30909-6603
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Country | US
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Telephone | 706-860-8717
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Fax | 706-860-1341
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Provider Business Mailing Address
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Address Line | 3665 WHEELER RD SUITE 2A
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City | AUGUSTA
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State | GA
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Zip | 30909-6603
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Country | US
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Telephone | 706-860-8717
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Fax | 706-860-1341
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DARRELL THOMAS BOUTWELL
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Credential | D.C.
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Telephone | 706-860-8717
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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 |
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License Number State | GA
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