Organization
BAYSIDE CHIROPRACTIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE D BOUCHER D.C. (OWNER)
(253) 753-6204
Entity
Organization
Contact information
Practice address
7307 40TH ST W STE B, UNIVERSITY PLACE, WA 98466-4385
(253) 753-6204
Mailing address
4250 ALTURUS ST W, UNIVERSITY PLACE, WA 98466-6612
(253) 753-8620
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
11178
TX
Other
Enumeration date
04/28/2009
Last updated
01/14/2023
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