Provider Demographics
NPI:1033312178
Name:OPTIMUM HEALTH CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-592-1915
Mailing Address - Street 1:10917 HIGHWAY 92
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6329
Mailing Address - Country:US
Mailing Address - Phone:770-592-1915
Mailing Address - Fax:770-592-1215
Practice Address - Street 1:10917 HIGHWAY 92
Practice Address - Street 2:SUITE 160
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6329
Practice Address - Country:US
Practice Address - Phone:770-592-1915
Practice Address - Fax:770-592-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty