Provider Demographics
NPI:1134267834
Name:OPTIMAL FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:OPTIMAL FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-584-4888
Mailing Address - Street 1:22 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9416
Mailing Address - Country:US
Mailing Address - Phone:973-584-4888
Mailing Address - Fax:973-584-1666
Practice Address - Street 1:22 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9416
Practice Address - Country:US
Practice Address - Phone:973-584-4888
Practice Address - Fax:973-584-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00605000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076617OtherMEDICARE ID- TYPE UNSPECIFIED
NJ076618OtherMEDICARE ID-TYPE UNSPECIF
NJ076617OtherMEDICARE ID- TYPE UNSPECIFIED