Provider Demographics
NPI:1023074176
Name:BOULEY, JACQUELINE ELISE (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ELISE
Last Name:BOULEY
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 1:652 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1407
Mailing Address - Country:US
Mailing Address - Phone:617-939-6752
Mailing Address - Fax:
Practice Address - Street 1:114 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2824
Practice Address - Country:US
Practice Address - Phone:617-939-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y45853Medicare PIN