Provider Demographics
NPI:1962510453
Name:OPTIMAL HEALTH CENTER
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-493-4463
Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:SUITE #1405
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-4463
Mailing Address - Fax:215-493-1810
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE #1405
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-4463
Practice Address - Fax:215-493-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADL06880L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty