Individual
DR. JOHN RANDALL BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.,B.C.A.O.
Contact information
Practice address
3665 WHEELER RD, SUITE 2A, AUGUSTA, GA 30909-6603
(706) 860-8717
(706) 860-1341
Mailing address
3665 WHEELER RD, SUITE 2A, AUGUSTA, GA 30909-6603
(706) 860-8717
(706) 860-1341
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR001886
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35ZCFLN
PTAN
GA
Enumeration date
02/01/2007
Last updated
02/23/2015
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