Healthcare Provider Details

I. General information

NPI: 1386835965
Provider Name (Legal Business Name): OPTIMAL SPINE & HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 S POWER RD STE 132
GILBERT AZ
85295-8490
US

IV. Provider business mailing address

5656 S POWER RD STE 132
GILBERT AZ
85295-8490
US

V. Phone/Fax

Practice location:
  • Phone: 480-688-4006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5716
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN FOX
Title or Position: PRESIDENT
Credential: DC
Phone: 480-985-0040