Healthcare Provider Details

I. General information

NPI: 1548307416
Provider Name (Legal Business Name): HOWARD J BOOS DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 S YALE AVE STE 205
TULSA OK
74136-3311
US

IV. Provider business mailing address

6717 S YALE AVE STE 205
TULSA OK
74136-3328
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-2992
  • Fax: 918-493-2994
Mailing address:
  • Phone: 918-749-2992
  • Fax: 918-493-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2068
License Number StateOK

VIII. Authorized Official

Name: DR. HOWARD JAMES BOOS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-749-2992