Healthcare Provider Details

I. General information

NPI: 1568490126
Provider Name (Legal Business Name): BOUKUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E INDIAN SCHOOL RD SUITE C
PHOENIX AZ
85018-5156
US

IV. Provider business mailing address

3520 E INDIAN SCHOOL RD SUITE C
PHOENIX AZ
85018-5156
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-9444
  • Fax:
Mailing address:
  • Phone: 602-954-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7724
License Number StateAZ

VIII. Authorized Official

Name: DR. DIMITRIOS SPIROPOULOS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 602-954-9444