Individual
DR. GENE LOUIS BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
26 MILL ST, FAIRFIELD, NJ 07004-3824
(736) 505-2259
Mailing address
26 MILL ST, FAIRFIELD, NJ 07004-3824
(973) 650-5225
(973) 345-4119
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
MC005511
NJ
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-1499484
QUALCARE
NJ
01
—
5489614
AETNA HMO/PPO
NJ
Enumeration date
01/25/2006
Last updated
04/03/2020
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