Provider Demographics
NPI:1922265909
Name:OPTIMUM HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:TUCHSCHERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-974-0392
Mailing Address - Street 1:4100 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3048
Mailing Address - Country:US
Mailing Address - Phone:720-974-0392
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:720-974-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6065261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center