Provider Demographics
NPI:1922051473
Name:BOUFFARD, RONALD PAUL (BS DC DABCI)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:BOUFFARD
Suffix:
Gender:M
Credentials:BS DC DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1849
Mailing Address - Country:US
Mailing Address - Phone:207-633-5500
Mailing Address - Fax:207-633-0805
Practice Address - Street 1:18 WEST STREET
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1849
Practice Address - Country:US
Practice Address - Phone:207-633-5500
Practice Address - Fax:207-633-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME030232OtherANTHEM/BC BLUE SHIELD
MEMM9405Medicare ID - Type Unspecified
U59141Medicare UPIN