Provider Demographics
NPI:1225356835
Name:BOUDREAUX SPINE & JOINT
Entity Type:Organization
Organization Name:BOUDREAUX SPINE & JOINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-338-6042
Mailing Address - Street 1:309 GOODE ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4562
Mailing Address - Country:US
Mailing Address - Phone:504-338-6042
Mailing Address - Fax:985-447-9578
Practice Address - Street 1:309 GOODE ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4562
Practice Address - Country:US
Practice Address - Phone:504-338-6042
Practice Address - Fax:985-447-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1496261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center