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General NPI Number Information
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NPI Number | 1326317496
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Entity Type | Organization
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Legal Business Name | OPTIMAL PERFORMANCE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 703 N MAIN ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1045
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Country | US
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Telephone | 812-684-0095
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Fax | 812-684-0096
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Provider Business Mailing Address
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Address Line | 703 N MAIN ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1045
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Country | US
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Telephone | 812-684-0095
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Fax | 812-684-0096
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNA N GOGEL
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Credential | D.C.
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Telephone | 812-684-0095
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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 | 08002600A
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License Number State | IN
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