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Individual
DR. JOHN RANDALL BOUTWELL
Active
Individual
DR. JOHN RANDALL BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.,B.C.A.O.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR001886
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35ZCFLN
PTAN
GA
Enumeration date
02/01/2007
Last updated
02/23/2015
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