Provider Demographics
NPI:1962673947
Name:OPTIMUM WELLNESS & REHAB CENTER
Entity Type:Organization
Organization Name:OPTIMUM WELLNESS & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:FARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-592-5650
Mailing Address - Street 1:PO BOX 31566
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77231-1566
Mailing Address - Country:US
Mailing Address - Phone:713-592-5650
Mailing Address - Fax:
Practice Address - Street 1:2600 S LOOP W
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2653
Practice Address - Country:US
Practice Address - Phone:713-592-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609061OtherBCBS
TXU71799Medicare UPIN