Provider Demographics
NPI:1508210956
Name:CAPITAL DISTRICT OPTIMAL HEALTH INC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT OPTIMAL HEALTH INC
Other - Org Name:HIGH PEAKS OPTIMAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHIANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-210-8717
Mailing Address - Street 1:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-5255
Mailing Address - Country:US
Mailing Address - Phone:518-523-4325
Mailing Address - Fax:
Practice Address - Street 1:6018 SENTINEL RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-3649
Practice Address - Country:US
Practice Address - Phone:518-523-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty