Provider Demographics
NPI:1255947636
Name:OPTIMUM HEALTH & PERFORMANCE
Entity type:Organization
Organization Name:OPTIMUM HEALTH & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-315-1570
Mailing Address - Street 1:228 LIBERTY DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1390
Mailing Address - Country:US
Mailing Address - Phone:603-315-1570
Mailing Address - Fax:
Practice Address - Street 1:116 S RIVER RD UNIT F
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6734
Practice Address - Country:US
Practice Address - Phone:603-315-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty