Provider Demographics
NPI:1114074531
Name:OPTIMAL HEALTH & WELLNESS P.C.
Entity Type:Organization
Organization Name:OPTIMAL HEALTH & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WUEBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-725-5733
Mailing Address - Street 1:25240 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8371
Mailing Address - Country:US
Mailing Address - Phone:563-340-3337
Mailing Address - Fax:
Practice Address - Street 1:568 BROOK FOREST AVE.
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9706
Practice Address - Country:US
Practice Address - Phone:815-725-5733
Practice Address - Fax:815-725-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILZ04890Medicare UPIN
IL211598Medicare ID - Type Unspecified