Provider Demographics
NPI:1114664976
Name:OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC.
Entity Type:Organization
Organization Name:OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC.
Other - Org Name:LIVING PROOF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:470-308-4108
Mailing Address - Street 1:1301 SHILOH RD NW STE 420
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7152
Mailing Address - Country:US
Mailing Address - Phone:470-308-4108
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 420
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7152
Practice Address - Country:US
Practice Address - Phone:703-084-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty