Healthcare Provider Details

I. General information

NPI: 1619221835
Provider Name (Legal Business Name): OPTIMAL HEALING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N LINCOLN AVE SUITE #1
CHICAGO IL
60614-7170
US

IV. Provider business mailing address

2202 N LINCOLN AVE SUITE #1
CHICAGO IL
60614-7170
US

V. Phone/Fax

Practice location:
  • Phone: 312-448-8122
  • Fax: 773-248-2058
Mailing address:
  • Phone: 312-448-8122
  • Fax: 773-248-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038012243
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038012243
License Number StateIL

VIII. Authorized Official

Name: DR. MINA H. PATEL
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 312-448-8122