Provider Demographics
NPI:1972772424
Name:OPTIMUM SPINE AND REHAB, INC
Entity Type:Organization
Organization Name:OPTIMUM SPINE AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-467-0302
Mailing Address - Street 1:1919 VETERANS MEMORIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 ESE LOOP323 STE 310
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9666
Practice Address - Country:US
Practice Address - Phone:903-939-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty