Provider Demographics
NPI:1780612374
Name:BOST, LESLIE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:BOST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1104839182OtherNPI
OKU94309Medicare UPIN
OK900522086Medicare PIN