Doctor Name: | DR. LYETTE ROSE BOUCHER |
NPI Number: | 1104168194 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | 038.012357 |
Business Practice Address: | 10971 Bonita Beach Rd Se Suite 3 Bonita Springs, FL - 341359028 |
Business Phone Number: | 2392217123 |
Business Fax Number: | |
Mailing Address: | 10971 Bonita Beach Rd Se, Suite 3 BONITA SPRINGS |
State: | FL |
Postal Code: | 341359028 |
Phone Number: | 2392217123 |
Fax Number: | |
NPI Enumeration Date: | 03/18/2013 |
NPI Last Update Date: | 12/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 038.012357 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |