Provider Demographics
NPI:1255612180
Name:BOUCHER, KRISTEN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:BOUCHER
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 1:174 RIVER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-5356
Mailing Address - Country:US
Mailing Address - Phone:315-373-4346
Mailing Address - Fax:
Practice Address - Street 1:124 CHAPEL CROSSING RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0529
Practice Address - Country:US
Practice Address - Phone:912-554-2002
Practice Address - Fax:912-554-2290
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor