Provider Demographics
NPI:1801634530
Name:OPTIMAL CHIROPRACTIC PC
Entity type:Organization
Organization Name:OPTIMAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:YOONKU
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-262-7718
Mailing Address - Street 1:120 SYLVAN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2541
Mailing Address - Country:US
Mailing Address - Phone:646-262-7718
Mailing Address - Fax:
Practice Address - Street 1:120 SYLVAN AVE STE 203
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2541
Practice Address - Country:US
Practice Address - Phone:646-262-7718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty