Provider Demographics
NPI:1548307416
Name:HOWARD J BOOS DC INC
Entity type:Organization
Organization Name:HOWARD J BOOS DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-749-2992
Mailing Address - Street 1:6717 S YALE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3328
Mailing Address - Country:US
Mailing Address - Phone:918-749-2992
Mailing Address - Fax:918-493-2994
Practice Address - Street 1:6717 S YALE AVE
Practice Address - Street 2:STE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3311
Practice Address - Country:US
Practice Address - Phone:918-749-2992
Practice Address - Fax:918-493-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2068261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100522154Medicare PIN