Provider Demographics
NPI:1750631800
Name:BOEKE, BRETT ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLAN
Last Name:BOEKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 E. HEBRON PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007
Mailing Address - Country:US
Mailing Address - Phone:972-428-3905
Mailing Address - Fax:972-428-3910
Practice Address - Street 1:2008 E. HEBRON PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007
Practice Address - Country:US
Practice Address - Phone:972-428-3905
Practice Address - Fax:972-428-3910
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor