Provider Demographics
NPI:1114459492
Name:OPTIMUM CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:OPTIMUM CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BALLITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-979-7100
Mailing Address - Street 1:8765 W KELTON LN
Mailing Address - Street 2:B-4 SUITE 150
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3584
Mailing Address - Country:US
Mailing Address - Phone:623-979-7100
Mailing Address - Fax:623-979-3577
Practice Address - Street 1:8765 W KELTON LN
Practice Address - Street 2:B-4 SUITE 150
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3584
Practice Address - Country:US
Practice Address - Phone:623-979-7100
Practice Address - Fax:623-979-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty