Individual
BRYAN GERARD BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
8119 CONNECTOR DR, FLORENCE, KY 41042-1469
(859) 283-2475
(859) 283-0097
Mailing address
8119 CONNECTOR DR, FLORENCE, KY 41042-1469
(859) 283-2475
(859) 283-0097
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5496
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K168830
MEDICARE PTAN
KY
Enumeration date
04/08/2006
Last updated
09/14/2017
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