Healthcare Provider Details

I. General information

NPI: 1164606992
Provider Name (Legal Business Name): OPTIMUM CHIROPRACTIC AND HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 LITTLE RIVER TPKE STE 100D
ANNANDALE VA
22003-2937
US

IV. Provider business mailing address

7535 LITTLE RIVER TPKE STE 100D
ANNANDALE VA
22003-2937
US

V. Phone/Fax

Practice location:
  • Phone: 703-658-0967
  • Fax: 703-658-0969
Mailing address:
  • Phone: 703-658-0967
  • Fax: 703-658-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: REZA NIKPOUR
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 703-658-0967