Provider Demographics
NPI:1508026329
Name:OPTIMUM HEALTH CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCCOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-357-1211
Mailing Address - Street 1:506 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1829
Mailing Address - Country:US
Mailing Address - Phone:641-357-1211
Mailing Address - Fax:641-357-1213
Practice Address - Street 1:506 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1829
Practice Address - Country:US
Practice Address - Phone:641-357-1211
Practice Address - Fax:641-357-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007088261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center