Provider Demographics
NPI:1700057155
Name:OPTIMUM WELLNESS AND REHAB CENTER
Entity Type:Organization
Organization Name:OPTIMUM WELLNESS AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:FARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-969-7741
Mailing Address - Street 1:2232 1092 ROAD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-969-7741
Mailing Address - Fax:281-969-7743
Practice Address - Street 1:2232 FM 1092 ROAD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:281-969-7741
Practice Address - Fax:281-969-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609061OtherBCBS
TXU71799Medicare UPIN