Provider Demographics
NPI:1972672079
Name:OPTIMAL CHIROPRACTIC HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:OPTIMAL CHIROPRACTIC HEALTH AND WELLNESS CENTER
Other - Org Name:OPTIMAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:NESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-698-1111
Mailing Address - Street 1:3315 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6587
Mailing Address - Country:US
Mailing Address - Phone:217-698-1111
Mailing Address - Fax:217-698-1110
Practice Address - Street 1:3315 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6587
Practice Address - Country:US
Practice Address - Phone:217-698-1111
Practice Address - Fax:217-698-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty