Provider Demographics
NPI:1164606992
Name:OPTIMUM CHIROPRACTIC AND HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:OPTIMUM CHIROPRACTIC AND HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-658-0967
Mailing Address - Street 1:7700 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2406
Mailing Address - Country:US
Mailing Address - Phone:703-658-0967
Mailing Address - Fax:703-658-0969
Practice Address - Street 1:7700 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2406
Practice Address - Country:US
Practice Address - Phone:703-658-0967
Practice Address - Fax:703-658-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01434Medicare PIN