Healthcare Provider Details

I. General information

NPI: 1700269511
Provider Name (Legal Business Name): TORQUE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 RIVERSIDE PKWY STE B SUITE 338
TULSA OK
74137-7422
US

IV. Provider business mailing address

PO BOX 700390 DEPT 469
TULSA OK
74170-0390
US

V. Phone/Fax

Practice location:
  • Phone: 214-675-0905
  • Fax: 214-317-4888
Mailing address:
  • Phone: 214-675-0905
  • Fax: 214-317-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CHALKIN
Title or Position: OWNER
Credential: DO
Phone: 214-675-0905