Provider Demographics
NPI:1487801890
Name:OPTIMUM CHIROPRACTIC CENTER, S.C.
Entity type:Organization
Organization Name:OPTIMUM CHIROPRACTIC CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OKI
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BSEE
Authorized Official - Phone:312-218-0087
Mailing Address - Street 1:1013 AUDUBON LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-8853
Mailing Address - Country:US
Mailing Address - Phone:815-230-0847
Mailing Address - Fax:
Practice Address - Street 1:1013 AUDUBON LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-8853
Practice Address - Country:US
Practice Address - Phone:815-230-0847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0380112233305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization