Provider Demographics
NPI:1972854040
Name:OPTIMAL HEALTH CHIROPRACTIC & ACUPUNCTURE, PA
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC & ACUPUNCTURE, PA
Other - Org Name:OPTIMAL HEALTH & CHIROPRACTIC, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-235-5505
Mailing Address - Street 1:405 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1641
Mailing Address - Country:US
Mailing Address - Phone:507-847-2112
Mailing Address - Fax:507-847-3545
Practice Address - Street 1:405 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1641
Practice Address - Country:US
Practice Address - Phone:507-478-2112
Practice Address - Fax:507-235-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty