Provider Demographics
NPI:1699387001
Name:OPTIMAL FUNCTION CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMAL FUNCTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:941-914-7246
Mailing Address - Street 1:744 SIGSBEE LOOP
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-2322
Mailing Address - Country:US
Mailing Address - Phone:941-914-7246
Mailing Address - Fax:
Practice Address - Street 1:6731 PROFESSIONAL PKWY W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8490
Practice Address - Country:US
Practice Address - Phone:941-914-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty