Individual
MR. ROBERT RALPH BOUCHARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1104 GAULT AVE S # A, FORT PAYNE, AL 35967-4920
(256) 844-8215
(256) 844-8210
Mailing address
1104 GAULT AVE S # A, FORT PAYNE, AL 35967-4920
(256) 844-8215
(256) 844-8210
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1987
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5150338BOU
BLUE CROSS
AL
01
—
631263185
TAX ID
AL
Enumeration date
10/02/2006
Last updated
01/03/2013
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