Provider Demographics
NPI:1073656583
Name:OPTIMAL HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-712-4100
Mailing Address - Street 1:2575 OLD GLORY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9585
Mailing Address - Country:US
Mailing Address - Phone:336-712-4100
Mailing Address - Fax:336-712-4144
Practice Address - Street 1:2575 OLD GLORY RD STE 300
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9585
Practice Address - Country:US
Practice Address - Phone:336-712-4100
Practice Address - Fax:336-712-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085VROtherBCBS
NC5901160Medicaid
NC5901160Medicaid
NC085VROtherBCBS