Organization
BACK TO BASICS CHIROPRACTIC., PLLC
Active
Other names
Carlene A Bolen DC
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CARRIE A BURKS (BILLING MANAGER)
(918) 251-8800
Entity
Organization
Contact information
Practice address
845 N ASPEN AVE, BROKEN ARROW, OK 74012-2242
(918) 251-8800
(918) 251-8802
Mailing address
845 N ASPEN AVE, BROKEN ARROW, OK 74012-2242
(918) 251-8800
(918) 251-8802
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3532
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083650295
INDIVIDUEAL NPI TYPE 1
OK
Enumeration date
03/02/2016
Last updated
03/02/2016
Update your record
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