Individual
DOUGLAS BOUCK, SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
11705 GRAVOIS RD, SAINT LOUIS, MO 63127-1803
(314) 843-4636
Mailing address
11705 GRAVOIS RD, SAINT LOUIS, MO 63127-1803
(314) 843-4636
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
004788
MO
Other
Enumeration date
07/05/2006
Last updated
09/22/2016
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