Provider Demographics
NPI:1902824451
Name:OPTIMAL HEALTH CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-992-5311
Mailing Address - Street 1:16517 VANDERBILT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7550
Mailing Address - Country:US
Mailing Address - Phone:239-992-5311
Mailing Address - Fax:239-947-6338
Practice Address - Street 1:16517 VANDERBILT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7550
Practice Address - Country:US
Practice Address - Phone:239-992-5311
Practice Address - Fax:239-947-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty