Provider Demographics
NPI:1649504341
Name:OPTIMAL LIVING LLC
Entity type:Organization
Organization Name:OPTIMAL LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HIRSCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-600-1394
Mailing Address - Street 1:18521 E QUEEN CREEK RD STE 105-430
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18471 E QUEEN CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-3628
Practice Address - Country:US
Practice Address - Phone:480-279-3960
Practice Address - Fax:480-279-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty