Provider Demographics
NPI:1346743689
Name:OPTIMUM PERFORMANCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OPTIMUM PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASISTENTE
Authorized Official - Prefix:MISS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ CARRELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-205-8564
Mailing Address - Street 1:PO BOX 363094
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:E3178 PASEO CRESTA
Practice Address - Street 2:
Practice Address - City:LEVITOWN
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-403-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty