MEDICARE: OPTIMAL HEALTH & PERFORMANCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	111NN0400X	Neurology Chiropractor

General Provider Information

NPI Number	:	1336787852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH & PERFORMANCE, LLC

Provider Business Mailing Address
First Line	:	13 N OAK AVE
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2433
Country	:	US
Telephone Number	:	931-651-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 N OAK AVE
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2433
Country	:	US
Telephone Number	:	931-651-1390
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA BETH MAINORD
Credential	:
Telephone Number	:	931-644-2686

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	12/16/2019

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