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General NPI Number Information
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NPI Number | 1457637472
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Entity Type | Organization
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Legal Business Name | OPTIMAL WELLNESS LLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 3017 N CYPRESS ST SUITE B
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City | WICHITA
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State | KS
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Zip | 67226-4024
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Country | US
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Telephone | 316-425-1911
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Fax | 316-425-3610
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Provider Business Mailing Address
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Address Line | 3017 N CYPRESS ST SUITE B
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City | WICHITA
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State | KS
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Zip | 67226-4024
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Country | US
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Telephone | 316-425-1911
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Fax | 316-425-3610
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. NATHAN HANDS
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Credential | D.C.
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Telephone | 316-425-1911
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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 | 0105267
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License Number State | KS
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