Provider Demographics
NPI:1881997716
Name:BOUCHARD, JONQUILLE (DO)
Entity type:Individual
Prefix:
First Name:JONQUILLE
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1610
Mailing Address - Country:US
Mailing Address - Phone:603-641-2070
Mailing Address - Fax:
Practice Address - Street 1:16 HIGH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1610
Practice Address - Country:US
Practice Address - Phone:603-641-2070
Practice Address - Fax:603-641-8084
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265561207Q00000X
NH16816204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine