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General NPI Number Information
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NPI Number | 1134341712
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL TESTING
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 521 HARRIS AVE
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City | PASADENA
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State | TX
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Zip | 77506-4610
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Country | US
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Telephone | 713-944-1796
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Fax |
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Provider Business Mailing Address
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Address Line | 521 HARRIS AVE
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City | PASADENA
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State | TX
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Zip | 77506-4610
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Country | US
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Telephone | 713-944-1796
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE D HICKS
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Credential | DC
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Telephone | 713-944-1796
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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 | 8698
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License Number State | TX
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