Individual
DR. RANDAL SCOTT BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1 CANYON DRIVE, KAYENTA, AZ 86033-2817
(928) 697-2547
(928) 697-2549
Mailing address
PO BOX 2817, KAYENTA, AZ 86033-2817
(928) 697-2547
(928) 697-2549
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5801
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1050201
ASHN
AZ
01
—
2111887
CCN FIRST HEALTH
AZ
01
—
218760-01
HMA
AZ
01
—
AZ0939060
BCBSAZ
AZ
Enumeration date
11/16/2006
Last updated
07/08/2007
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