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General NPI Number Information
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NPI Number | 1114074531
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH & WELLNESS P.C.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 568 BROOK FOREST AVE.
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City | SHOREWOOD
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State | IL
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Zip | 60404-9706
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Country | US
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Telephone | 815-725-5733
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Fax | 815-725-5722
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Provider Business Mailing Address
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Address Line | 25240 BALMORAL DR
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City | SHOREWOOD
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State | IL
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Zip | 60431-8371
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Country | US
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Telephone | 563-340-3337
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN M. WUEBBEN
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Credential | D.C.
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Telephone | 815-725-5733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-010057
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License Number State | IL
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