Provider Demographics
NPI:1235250036
Name:BOULOM, JEUDI TAING (DC)
Entity Type:Individual
Prefix:DR
First Name:JEUDI
Middle Name:TAING
Last Name:BOULOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15608 18TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8800
Mailing Address - Country:US
Mailing Address - Phone:206-779-8718
Mailing Address - Fax:206-202-1575
Practice Address - Street 1:15608 18TH PL W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8800
Practice Address - Country:US
Practice Address - Phone:425-773-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor