Provider Demographics
NPI:1225606395
Name:OPTIMUS VITAE LLC
Entity Type:Organization
Organization Name:OPTIMUS VITAE LLC
Other - Org Name:ALASKA MED SPA AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-995-1622
Mailing Address - Street 1:2011 ABBOTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3400
Mailing Address - Country:US
Mailing Address - Phone:303-995-1622
Mailing Address - Fax:
Practice Address - Street 1:2011 ABBOTT RD STE C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3400
Practice Address - Country:US
Practice Address - Phone:303-995-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty