Provider Demographics
NPI:1306098371
Name:BOMAN, DAVID (DC, CFMP, OT/L, MBA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BOMAN
Suffix:
Gender:M
Credentials:DC, CFMP, OT/L, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FRANKLIN AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-2057
Mailing Address - Country:US
Mailing Address - Phone:254-307-3113
Mailing Address - Fax:
Practice Address - Street 1:601 FRANKLIN AVE APT 4E
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2057
Practice Address - Country:US
Practice Address - Phone:254-307-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOTOOOO2375225X00000X
TX14090111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist