MEDICARE: OPTIMAL HEALTH CHIROPRACTIC, PLC

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	CH9212	FL

General Provider Information

NPI Number	:	1902824451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH CHIROPRACTIC, PLC

Provider Business Mailing Address
First Line	:	16517 VANDERBILT DR
Second Line	:	SUITE 1
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7550
Country	:	US
Telephone Number	:	239-992-5311
Fax Number	:	239-947-6338

Provider Business Practice Location Address
First Line	:	16517 VANDERBILT DR
Second Line	:	SUITE 1
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7550
Country	:	US
Telephone Number	:	239-992-5311
Fax Number	:	239-947-6338

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN ROBERT SMITH
Credential	:	D.C.
Telephone Number	:	239-992-5311

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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