Provider Demographics
NPI:1376688200
Name:BOUCHARD, CINDY A (DC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:BOUCHARD
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 1:42 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2709
Mailing Address - Country:US
Mailing Address - Phone:207-493-0900
Mailing Address - Fax:207-493-7800
Practice Address - Street 1:42 HIGH ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2709
Practice Address - Country:US
Practice Address - Phone:207-493-0900
Practice Address - Fax:207-493-7800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME034516OtherANTHEM BLUECROSS AND BLUE
MEMM7034Medicare ID - Type UnspecifiedMEDICARE
MEU67987Medicare UPIN