Provider Demographics
NPI:1285024307
Name:OPTIMAL HEALTH AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD
Authorized Official - Phone:916-583-2632
Mailing Address - Street 1:6005 FLORIN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2487
Mailing Address - Country:US
Mailing Address - Phone:916-583-2632
Mailing Address - Fax:866-236-0004
Practice Address - Street 1:6005 FLORIN RD STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2487
Practice Address - Country:US
Practice Address - Phone:916-583-2632
Practice Address - Fax:866-236-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24184111N00000X, 111NI0900X, 111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty