Healthcare Provider Details

I. General information

NPI: 1851944532
Provider Name (Legal Business Name): OPTIMAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 FORDING ISLAND RD
HILTON HEAD SC
29926-1174
US

IV. Provider business mailing address

1544 FORDING ISLAND RD
HILTON HEAD SC
29926-1174
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-7836
  • Fax: 843-757-7837
Mailing address:
  • Phone: 843-757-7836
  • Fax: 843-757-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY C MORRIS
Title or Position: CEO
Credential: DC
Phone: 843-757-7836