Provider Demographics
NPI:1578622015
Name:BOUDREAUX, DANIEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WESTCOTT ST
Mailing Address - Street 2:215
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7094
Mailing Address - Country:US
Mailing Address - Phone:713-880-4444
Mailing Address - Fax:713-880-3886
Practice Address - Street 1:230 WESTCOTT ST
Practice Address - Street 2:215
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7094
Practice Address - Country:US
Practice Address - Phone:713-880-4444
Practice Address - Fax:713-880-3886
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H9620OtherBLUE CROSS BLUE SHIELD
TX8H9620OtherBLUE CROSS BLUE SHIELD