Provider Demographics
NPI:1063522852
Name:BOUTIN, STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BOUTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7410 NEW LA GRANGE RD
Mailing Address - Street 2:STE 304
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4871
Mailing Address - Country:US
Mailing Address - Phone:502-426-1330
Mailing Address - Fax:502-426-1337
Practice Address - Street 1:7410 NEW LAGRANGE ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-426-1330
Practice Address - Fax:502-426-1337
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor