Healthcare Provider Details

I. General information

NPI: 1346605599
Provider Name (Legal Business Name): OPTIMUM HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 PENNSYLVANIA AVE 3RD FLOOR
WILMINGTON DE
19806
US

IV. Provider business mailing address

2323 PENNSYLVANIA AVE 3RD FLOOR
WILMINGTON DE
19806-1332
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-9000
  • Fax: 302-225-9005
Mailing address:
  • Phone: 302-225-9000
  • Fax: 302-225-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000477
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberF11000477
License Number StateDE

VIII. Authorized Official

Name: STACEY Y.N. ANDERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 302-225-9000