Provider Demographics
NPI:1942459987
Name:OPTIMAL PERFORMANCE SPECIALISTS CLINICS, LLC
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE SPECIALISTS CLINICS, LLC
Other - Org Name:INNATE WELLNESS CENTER, LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARRON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-526-2211
Mailing Address - Street 1:220 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:507-526-2211
Mailing Address - Fax:507-526-3003
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013
Practice Address - Country:US
Practice Address - Phone:507-526-2211
Practice Address - Fax:507-526-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty