Healthcare Provider Details

I. General information

NPI: 1033312178
Provider Name (Legal Business Name): OPTIMUM HEALTH CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10917 HIGHWAY 92 SUITE 160
WOODSTOCK GA
30188-6329
US

IV. Provider business mailing address

10917 HIGHWAY 92 SUITE 160
WOODSTOCK GA
30188-6329
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-1915
  • Fax: 770-592-1215
Mailing address:
  • Phone: 770-592-1915
  • Fax: 770-592-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO07313
License Number StateGA

VIII. Authorized Official

Name: DR. CATHYJO WENDLAND
Title or Position: OWNER
Credential: D.C.
Phone: 770-592-1915