Provider Demographics
NPI:1407056609
Name:OPTIMUM HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HOAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-845-7279
Mailing Address - Street 1:6521 CREEDMOOR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3668
Mailing Address - Country:US
Mailing Address - Phone:919-845-7279
Mailing Address - Fax:919-845-7848
Practice Address - Street 1:6521 CREEDMOOR RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3668
Practice Address - Country:US
Practice Address - Phone:919-845-7279
Practice Address - Fax:919-845-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU69318Medicare UPIN