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DR. RANDAL SCOTT BOUCHARD D.C.

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1164595179

Individual Registrant:
DR. RANDAL SCOTT BOUCHARD D.C.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1 CANYON DRIVE  KAYENTA, AZ 86033-2817 US
Tel: 928-697-2547  Fax: 928-697-2549

Contact information for business:
PO BOX 2817  KAYENTA, AZ 86033-2817 US
Tel: 928-697-2547  Fax: 928-697-2549

Registration Information:
NPI: 1164595179
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
AZ5801

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
ASHN1050201AZ01
CCN FIRST HEALTH2111887AZ01
HMA218760-01AZ01
BCBSAZAZ0939060AZ01




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