Healthcare Provider Details

I. General information

NPI: 1144491093
Provider Name (Legal Business Name): OPTIMA MULTICARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85220-4010
US

IV. Provider business mailing address

837 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85220-4010
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0991
  • Fax: 490-982-2734
Mailing address:
  • Phone: 480-982-0991
  • Fax: 490-982-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3902
License Number StateAZ

VIII. Authorized Official

Name: DR. ROY A OTTINGER II
Title or Position: SOLE PROPRIETOR
Credential: DC
Phone: 480-982-0991