Provider Demographics
NPI:1104839182
Name:BROOKWOOD CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BROOKWOOD CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-691-3838
Mailing Address - Street 1:810 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9334
Mailing Address - Country:US
Mailing Address - Phone:405-691-3838
Mailing Address - Fax:405-691-3837
Practice Address - Street 1:810 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9334
Practice Address - Country:US
Practice Address - Phone:405-691-3838
Practice Address - Fax:405-691-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU94309Medicare UPIN
OK900522086Medicare PIN