Provider Demographics
NPI:1174795124
Name:OPTIMAL HEALTH CHIROPRACTIC P. C.
Entity type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-714-1553
Mailing Address - Street 1:9956 N MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1077
Mailing Address - Country:US
Mailing Address - Phone:410-629-1845
Mailing Address - Fax:410-629-1846
Practice Address - Street 1:9956 N MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1077
Practice Address - Country:US
Practice Address - Phone:410-629-1845
Practice Address - Fax:410-629-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty