Provider Demographics
NPI:1225296643
Name:OPTIMAL HEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-981-7773
Mailing Address - Street 1:2833 VEROT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6411
Mailing Address - Country:US
Mailing Address - Phone:337-981-7773
Mailing Address - Fax:337-983-0036
Practice Address - Street 1:2833 VEROT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6411
Practice Address - Country:US
Practice Address - Phone:337-981-7773
Practice Address - Fax:337-983-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B737Medicare PIN