Active NPI
Johnathan Ory Boudreaux, DC
- Chiropractor
- Monroe, LA
National Provider Identifier
1114539418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1913
- Practice address
- 3219 Sterlington Rd
Monroe, LA 71203-2519 - Phone
- (318) 387-5388
- NPI assigned
- Aug 18, 2020
- Last updated
- Aug 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1913 | LA | Primary |
Addresses
Primary practice location
3219 Sterlington Rd
Monroe, LA 71203-2519
Mailing address
3219 Sterlington Rd
Monroe, LA 71203-2519
Phone (318) 387-5388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1913 | LA | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1114539418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3219 STERLINGTON RD",
"city": "MONROE",
"state": "LA",
"postal_code": "712032519",
"telephone_number": "318-387-5388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3219 STERLINGTON RD",
"city": "MONROE",
"state": "LA",
"postal_code": "712032519",
"telephone_number": "318-387-5388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAUX",
"first_name": "JOHNATHAN",
"middle_name": "ORY",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-18",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "LA",
"license": "1913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.