Healthcare Provider Details

I. General information

NPI: 1972672079
Provider Name (Legal Business Name): OPTIMAL CHIROPRACTIC HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 ROBBINS RD
SPRINGFIELD IL
62704-6587
US

IV. Provider business mailing address

3315 ROBBINS RD
SPRINGFIELD IL
62704-6587
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-1111
  • Fax: 217-698-1110
Mailing address:
  • Phone: 217-698-1111
  • Fax: 217-698-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MARTHA VICTORIA NESSLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 217-698-1111