Provider Demographics
NPI:1295312007
Name:OPTIMUM HEALTH CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-217-4513
Mailing Address - Street 1:5833 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1163
Mailing Address - Country:US
Mailing Address - Phone:269-344-4057
Mailing Address - Fax:269-344-5473
Practice Address - Street 1:5833 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1163
Practice Address - Country:US
Practice Address - Phone:269-344-4057
Practice Address - Fax:269-344-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty