Provider Demographics
NPI:1801409503
Name:OPTIMAL CARE CHIROPRACTIC
Entity type:Organization
Organization Name:OPTIMAL CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-699-5086
Mailing Address - Street 1:2759 US HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8949
Mailing Address - Country:US
Mailing Address - Phone:630-699-5086
Mailing Address - Fax:630-982-6550
Practice Address - Street 1:2759 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8949
Practice Address - Country:US
Practice Address - Phone:630-699-5086
Practice Address - Fax:630-982-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty