Individual
PATRICIA BOULOGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
935
MA
111NS0005X
Sports Physician Chiropractor
935
MA
171100000X
Acupuncturist
—
—
Other
Enumeration date
09/10/2009
Last updated
08/08/2012
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