Individual
DR. MARY ANN BOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
3901 HAGAN ST STE C, BLOOMINGTON, IN 47401-8516
(812) 336-7552
(812) 336-7556
Mailing address
5229 W VERNAL PIKE, BLOOMINGTON, IN 47404-9661
(812) 219-4927
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001999A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200341440
—
IN
Enumeration date
09/14/2005
Last updated
01/30/2013
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