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Organization
KINMED, P.A.
Active
Organization
KINMED, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYETTE BOUCHER DC (PRESIDENT)
(239) 948-1222
Entity
Organization
Contact information
Practice address
19910 S TAMIAMI TRL STE C, ESTERO, FL 33928-4140
(239) 948-1222
(239) 948-1220
Mailing address
19910 S TAMIAMI TRL STE C, ESTERO, FL 33928-4140
(239) 948-1222
(239) 948-1220
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
FL
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
FL
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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