MEDICARE: BOUCHARD CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2324558	MI

General Provider Information

NPI Number	:	1134542517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUCHARD CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	12839 CHIPPEWA DR
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48088-1816
Country	:	US
Telephone Number	:	248-767-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	27322 23 MILE RD
Second Line	:	SUITE 3
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2032
Country	:	US
Telephone Number	:	586-231-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. KRISTY SUE BOUCHARD
Credential	:	D.C.
Telephone Number	:	248-767-2183

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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