Provider Demographics
NPI:1700070729
Name:OPTIMAL HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-438-3988
Mailing Address - Street 1:12995 SHERIDAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1488
Mailing Address - Country:US
Mailing Address - Phone:303-466-3988
Mailing Address - Fax:303-466-3878
Practice Address - Street 1:12995 SHERIDAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1488
Practice Address - Country:US
Practice Address - Phone:303-466-3988
Practice Address - Fax:303-466-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty