Provider Demographics
NPI:1407941438
Name:BOUCHER, MICHAEL RONALD (D C)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RONALD
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1879
Mailing Address - Country:US
Mailing Address - Phone:508-998-3816
Mailing Address - Fax:
Practice Address - Street 1:2834 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3412
Practice Address - Country:US
Practice Address - Phone:508-998-3001
Practice Address - Fax:508-998-1461
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 1837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor