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General NPI Number Information
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NPI Number | 1366649816
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC WELLNESS P.C
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 MAMARONECK AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4263
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Country | US
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Telephone | 914-220-0226
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Fax |
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Provider Business Mailing Address
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Address Line | 18 LINK CT
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City | NEW CITY
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State | NY
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Zip | 10956-1623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. PAUL CHRISTOPHER MASELLI
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Credential | D.C.
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Telephone | 914-220-0226
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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 | X010784-1
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License Number State | NY
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