Derek Lane Boudreaux D.C.

NPI 1669640819 - Chiropractor - 111N00000X

NPI Details
NPI 1669640819
Gender Male
Enumeration Date 02/11/2008
Last Updated 02/11/2008
Entity Type Individual
Active Over 8 years ago
Practice Location
3660 CANTON RD
SUITE 140
MARIETTA GA, 30066-2660, US
Phone (770) 596-6367
Fax (770) 928-1471
Business Location
3660 CANTON RD
SUITE 140
MARIETTA GA, 30066-2660, US
Phone (770) 596-6367
Fax (770) 928-1471
Toxanomy
Taxonomy Code 111N00000X
License State Georgia
License Number 008213
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According to our database, Dr. Derek Lane Boudreaux D.C. NPI is 1669640819, taxonomy code is 111N00000X and license number is 008213, license state is located at Georgia. Derek Lane Boudreaux D.C. physically located at 3660 Canton Rd, Marietta GA, 30066-2660. NPI Number Derek Lane Boudreaux D.C. has the Individual type.

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1669640819 NPI number is provided on an as is basis without warranty of any kind. 1669640819 is maintained by the National Plan & Provider Enumeration System. The contents of Derek Lane Boudreaux D.C. are for informational purposes only.