Provider Demographics
NPI:1295598753
Name:OPTIMAL HEALTH CHIROPRACTIC AND SPORTS INJURY
Entity type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC AND SPORTS INJURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-295-0366
Mailing Address - Street 1:556 EGG HARBOR RD STE A
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2326
Mailing Address - Country:US
Mailing Address - Phone:856-295-0366
Mailing Address - Fax:
Practice Address - Street 1:556 EGG HARBOR RD STE A
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2326
Practice Address - Country:US
Practice Address - Phone:856-295-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty