Healthcare Provider Details

I. General information

NPI: 1306098371
Provider Name (Legal Business Name): DAVID BOMAN DC, CFMP, OT/L, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FRANKLIN AVE APT 4E
WACO TX
76701-2057
US

IV. Provider business mailing address

601 FRANKLIN AVE APT 4E
WACO TX
76701-2057
US

V. Phone/Fax

Practice location:
  • Phone: 254-307-3113
  • Fax:
Mailing address:
  • Phone: 254-307-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTOOOO2375
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number14090
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: