Provider Demographics
NPI:1407829484
Name:OPTIMA THE CENTER FOR SPINAL REHABILITATION
Entity Type:Organization
Organization Name:OPTIMA THE CENTER FOR SPINAL REHABILITATION
Other - Org Name:OPTIMA REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-632-4754
Mailing Address - Street 1:3920 N. UNION BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4907
Mailing Address - Country:US
Mailing Address - Phone:719-634-4754
Mailing Address - Fax:719-471-3734
Practice Address - Street 1:3920 N. UNION BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4907
Practice Address - Country:US
Practice Address - Phone:719-634-4754
Practice Address - Fax:719-471-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3773111NR0400X
111NR0400X, 225100000X
CO11645225100000X
COAT.000139322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
802537Medicare ID - Type Unspecified
500168Medicare ID - Type Unspecified