Provider Demographics
NPI:1104168194
Name:BOUCHER, LYETTE (DC)
Entity type:Individual
Prefix:DR
First Name:LYETTE
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 TAVILLA CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-3404
Mailing Address - Country:US
Mailing Address - Phone:239-325-8226
Mailing Address - Fax:239-325-8226
Practice Address - Street 1:5644 TAVILLA CIR STE 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-3404
Practice Address - Country:US
Practice Address - Phone:239-325-8226
Practice Address - Fax:239-325-8226
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012357111N00000X
FLCH11313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor