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General NPI Number Information
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NPI Number | 1114664976
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Entity Type | Organization
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Legal Business Name | OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC.
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Dates
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Enumeration Date | 05/13/2022
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 1301 SHILOH RD NW STE 420
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City | KENNESAW
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State | GA
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Zip | 30144-7152
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Country | US
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Telephone | 703-084-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 SHILOH RD NW STE 420
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City | KENNESAW
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State | GA
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Zip | 30144-7152
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Country | US
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Telephone | 470-308-4108
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JAMES FERRANTE
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Credential | DC
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Telephone | 470-308-4108
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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 |
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License Number State |
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