Provider Demographics
NPI:1912364159
Name:OHAW OF SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:OHAW OF SAN ANTONIO, LLC
Other - Org Name:OPTIMAL HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-681-3333
Mailing Address - Street 1:5819 NW LOOP 410
Mailing Address - Street 2:#152
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2520
Mailing Address - Country:US
Mailing Address - Phone:210-681-3333
Mailing Address - Fax:210-681-3333
Practice Address - Street 1:5819 NW LOOP 410
Practice Address - Street 2:#152
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2520
Practice Address - Country:US
Practice Address - Phone:210-681-3333
Practice Address - Fax:210-681-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty