Provider Demographics
NPI:1275156705
Name:OPTIMUM CHIROPRACTIC PC
Entity Type:Organization
Organization Name:OPTIMUM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:VOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-579-4629
Mailing Address - Street 1:7205 VISTA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9360
Mailing Address - Country:US
Mailing Address - Phone:515-225-9200
Mailing Address - Fax:
Practice Address - Street 1:8088 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2450
Practice Address - Country:US
Practice Address - Phone:515-225-9200
Practice Address - Fax:515-225-0123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM CHIROPRACTIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty