Provider Demographics
NPI:1730666520
Name:OPTIMAL HEALTH CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:LIFETIME CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF OPTIMAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-608-5360
Mailing Address - Street 1:105 E BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1606
Mailing Address - Country:US
Mailing Address - Phone:563-927-9400
Mailing Address - Fax:
Practice Address - Street 1:105 E BUTLER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1606
Practice Address - Country:US
Practice Address - Phone:563-927-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty