Provider Demographics
NPI:1598276008
Name:OPTIMAL HEALTH AND SPINE CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH AND SPINE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-936-0007
Mailing Address - Street 1:9809 FURLONG TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0452
Mailing Address - Country:US
Mailing Address - Phone:607-227-7869
Mailing Address - Fax:
Practice Address - Street 1:10320 MALLARD CREEK RD STE 280
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5214
Practice Address - Country:US
Practice Address - Phone:980-938-5221
Practice Address - Fax:980-938-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty