Provider Demographics
NPI:1164565768
Name:OPTIMED FITNESS MEDICAL REHAB & WEIGHT LOSS CENTER, PC
Entity Type:Organization
Organization Name:OPTIMED FITNESS MEDICAL REHAB & WEIGHT LOSS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOWY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-866-0677
Mailing Address - Street 1:13206 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5394
Mailing Address - Country:US
Mailing Address - Phone:602-866-3454
Mailing Address - Fax:602-866-3454
Practice Address - Street 1:13206 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5394
Practice Address - Country:US
Practice Address - Phone:602-866-3454
Practice Address - Fax:602-866-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty