Provider Demographics
NPI:1184694788
Name:BOUCHER, GENE LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:LOUIS
Last Name:BOUCHER
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 1:26 MILL ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3824
Mailing Address - Country:US
Mailing Address - Phone:973-650-5225
Mailing Address - Fax:973-345-4119
Practice Address - Street 1:26 MILL ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3824
Practice Address - Country:US
Practice Address - Phone:736-505-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
NJMC005511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5489614OtherAETNA HMO/PPO
NJ37-1499484OtherQUALCARE
NJ37-1499484OtherHORIZON BC/BS
NJ5489614OtherAETNA HMO/PPO
NJ37-1499484OtherHORIZON BC/BS