Healthcare Provider Details

I. General information

NPI: 1467997817
Provider Name (Legal Business Name): OPTIMUM HEALTH CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 E FOWLER AVE STE C
TAMPA FL
33617-2181
US

IV. Provider business mailing address

177A E MAIN ST STE 376
NEW ROCHELLE NY
10801-5711
US

V. Phone/Fax

Practice location:
  • Phone: 813-666-5379
  • Fax: 347-352-8331
Mailing address:
  • Phone: 813-666-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number11611
License Number StateFL

VIII. Authorized Official

Name: DR. MOHSEN RADPASAND
Title or Position: OWNER OF S-CORPORATION
Credential: D.C., MS
Phone: 813-666-5379