Provider Demographics
NPI:1598254492
Name:AWAKEN OPTIMAL HEALTH LLC
Entity Type:Organization
Organization Name:AWAKEN OPTIMAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-489-4444
Mailing Address - Street 1:503 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1323
Mailing Address - Country:US
Mailing Address - Phone:570-489-4444
Mailing Address - Fax:570-489-3333
Practice Address - Street 1:503 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18447-1323
Practice Address - Country:US
Practice Address - Phone:570-489-4444
Practice Address - Fax:570-489-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006471-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASM833642OtherMEDICARE
PA5755131OtherAETNA