Provider Demographics
NPI:1477785889
Name:OPTIMUM HEALTH AND SPINAL CARE
Entity Type:Organization
Organization Name:OPTIMUM HEALTH AND SPINAL CARE
Other - Org Name:MOUNTAIN VALLEY INJURY & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-256-0006
Mailing Address - Street 1:392 E 12300 S STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8043
Mailing Address - Country:US
Mailing Address - Phone:801-849-1029
Mailing Address - Fax:801-890-0513
Practice Address - Street 1:392 E 12300 S STE C
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8043
Practice Address - Country:US
Practice Address - Phone:801-849-1029
Practice Address - Fax:801-890-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7413155-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty