MEDICARE: DR. DANIEL A BOUDREAUX DC

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	6967	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8H9620	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1578622015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A BOUDREAUX DC

Provider Business Mailing Address
First Line	:	230 WESTCOTT ST
Second Line	:	215
City	:	HOUSTON
State	:	TX
Zip	:	77007-7094
Country	:	US
Telephone Number	:	713-880-4444
Fax Number	:	713-880-3886

Provider Business Practice Location Address
First Line	:	230 WESTCOTT ST
Second Line	:	215
City	:	HOUSTON
State	:	TX
Zip	:	77007-7094
Country	:	US
Telephone Number	:	713-880-4444
Fax Number	:	713-880-3886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	11/27/2007

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