Provider Demographics
NPI:1881742112
Name:OPTIMUM CHIROPRACTIC AND WELLNESS PLLC
Entity type:Organization
Organization Name:OPTIMUM CHIROPRACTIC AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-936-9353
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1103
Mailing Address - Country:US
Mailing Address - Phone:623-936-9353
Mailing Address - Fax:480-539-4685
Practice Address - Street 1:10320 W MCDOWELL RD STE N1447
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-4879
Practice Address - Country:US
Practice Address - Phone:623-936-9353
Practice Address - Fax:480-539-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty