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General NPI Number Information
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NPI Number | 1487801890
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC CENTER, S.C.
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 1013 AUDUBON LN
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City | AURORA
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State | IL
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Zip | 60506-8853
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Country | US
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Telephone | 815-230-0847
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 AUDUBON LN
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City | AURORA
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State | IL
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Zip | 60506-8853
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Country | US
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Telephone | 815-230-0847
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OKI KIM VILLARREAL
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Credential | DC, BSEE
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Telephone | 312-218-0087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0380112233
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License Number State | IL
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