Provider Demographics
NPI:1639425838
Name:OPTIMAL HEALTH CHIROPRACTIC AND NUTRITION
Entity type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC AND NUTRITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-691-3477
Mailing Address - Street 1:4455 TELEGRAPH RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3354
Mailing Address - Country:US
Mailing Address - Phone:314-691-3477
Mailing Address - Fax:
Practice Address - Street 1:4455 TELEGRAPH RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3354
Practice Address - Country:US
Practice Address - Phone:314-691-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024678261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center