Provider Demographics
NPI:1841415783
Name:OPTIMUM FUNCTION LLC
Entity Type:Organization
Organization Name:OPTIMUM FUNCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LMT
Authorized Official - Phone:503-866-9739
Mailing Address - Street 1:7704 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3017
Mailing Address - Country:US
Mailing Address - Phone:503-866-9739
Mailing Address - Fax:
Practice Address - Street 1:1201 SW 12TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2031
Practice Address - Country:US
Practice Address - Phone:503-274-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3622111N00000X
OR10250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty