Provider Demographics
NPI:1619098993
Name:OPTIMUM HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-508-3291
Mailing Address - Street 1:8945 RIDGE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2036
Mailing Address - Country:US
Mailing Address - Phone:205-508-3291
Mailing Address - Fax:205-508-3022
Practice Address - Street 1:8945 RIDGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2036
Practice Address - Country:US
Practice Address - Phone:205-508-3291
Practice Address - Fax:205-508-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006969L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2073300000OtherKEYSTONE PROVIDER NUMBER
PA747769OtherPERSONAL CHOICE PROVIDER
PA=========OtherAETNA PROVIDER NUMBER
PA037746Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER