BRYAN GERARD BOUDREAUX (NPI# 1770546038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770546038 |
| Entity Type | Individual |
| Full Name | BRYAN GERARD BOUDREAUX |
| Credential | D.C. |
| Practice Address |
8119 Connector Dr Florence KY 41042-1469 |
| Practice Telephone | 8592832475 |
| Practice Fax Number | 8592830097 |
| Mailing Telephone | 8592832475 |
| Mailing Fax Number | 8592830097 |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2017-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 5496 | KY | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | MEDICARE PTAN | K168830 | 01 |
| Street Address |
8119 CONNECTOR DR |
| City | FLORENCE |
| State | KY |
| Zip Code | 41042-1469 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417125071 | Robin Starr Pace | Chiropractor | 8119 Connector Dr, Florence, KY 41042-1469 | 2008-02-18 |
| 1285776377 | Benton Dammel | Chiropractor | 8119 Connector Dr, Florence, KY 41042-1469 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710596010 | Stacey Deann Cruse | Counselor | 71 Cavalier Blvd #303, Florance, KY 41042 | 2020-07-23 |
| 1760044705 | Loretta Macaluso | Speech-Language Pathologist | 1515 Cavalry Drive, Suite 202, Florence, KY 41042 | 2019-06-29 |
| 1659879559 | Christina Shrader | Counselor | 71 Cavalier Blvd Ste 113, Florence, KY 41042 | 2018-01-25 |
| 1891200267 | Rachel Knuehl | Case Manager/Care Coordinator | 8140 Dream Street, Florence, KY 41042 | 2017-12-07 |
| 1427560697 | Marie Nicole Sartori | Nurse Practitioner | 7766 Ewing Blvd Ste 100, Florence, KY 41042 | 2017-10-27 |
| 1669903910 | Northern Kentucky Smiles | Dentist | 1481 Cavalry Drive, Suite 100, Florence, KY 41042 | 2017-03-27 |
| 1306394937 | Mary Austin | Nurse Practitioner | 7766 Ewing Boulevard, Florence, KY 41042 | 2016-09-12 |
| 1598211633 | Samantha Growe | Counselor | 7000 Houston Rd Ste 16, Florence, KY 41042 | 2016-08-29 |
| 1982079299 | Jessica Adelyn Goodridge | Doula | 2224 Forest Lawn Dr., Florence, KY 41042 | 2015-12-11 |
| 1083083414 | Victoria Maruca Havron | Psychologist | 6900 Houston Rd Ste 11, Florence, KY 41042 | 2015-09-16 |
| Find all providers in zip 41042 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770102980 | Christopher B Gardner | Chiropractor | 205 N Irby St Ste B, Florence, SC 29501-2805 | 2020-04-09 |
| 1184254757 | Ronald Corbin Critz | Chiropractor | 436 W Palmetto St Ste B, Florence, SC 29501-4425 | 2020-01-22 |
| 1982140406 | Samantha Jo Walton | Chiropractor | 126 Warley St, Florence, SC 29501-4443 | 2017-01-07 |
| 1104362730 | William Jumper | Chiropractor | 133 Ana Dr, Florence, AL 35630-1731 | 2017-01-06 |
| 1952752818 | Jack Carter Shackelford | Chiropractor | 311 West Palmetto Street, Florence, SC 29501 | 2016-06-22 |
| 1215300983 | Taylor Reagan Huntley | Chiropractor | 1451 W Palmetto St, Florence, SC 29501-4173 | 2015-11-03 |
| 1578993820 | Jennifer Marlena Evans | Chiropractor | 420 Pilchard Ct, Florence, SC 29505-5266 | 2013-11-24 |
| 1467715268 | Florence-carlton Chiropractic | Chiropractor | 5537 Us Highway 93 N, Suite A, Florence, MT 59833-6845 | 2012-06-18 |
| 1821358169 | Chiropractic and Massage Center, Psc | Chiropractor | 6052 Ridge Rd, Suite B, Florence, KY 41042-1362 | 2012-05-21 |
| 1124315346 | Palmetto Chiromed | Chiropractor | 2147a Hoffmeyer Rd, Florence, SC 29501-4015 | 2011-07-08 |
| Find all providers in FLORENCE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.