Robert  R  Bouchard  Jr  DC
Contract Details
Facility name
Provider ID
P000000175
NPI
1497848428
Tax ID
631263185
Effective Date
3/19/2004
Last Updated
11/21/2011
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1104 Gault Ave South Suite A
Fort Payne, AL 35967
United States
County
De Kalb
Phone
2568448215 (Phone)
Billing Details
Address
Specialty Type
Chiropractic Medicine
Map
Address