Provider Demographics
NPI:1013799550
Name:OPTIMIZE HEALTH 360
Entity Type:Organization
Organization Name:OPTIMIZE HEALTH 360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DENUNZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-592-5301
Mailing Address - Street 1:291 S COLLIER BLVD UNIT 109
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-4830
Mailing Address - Country:US
Mailing Address - Phone:239-394-7221
Mailing Address - Fax:
Practice Address - Street 1:291 S COLLIER BLVD UNIT 109
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-4830
Practice Address - Country:US
Practice Address - Phone:239-394-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty